Ileosigmoid knot complicated by gastric and splenic mucormycosis: a lethal combination

Area of Science:

• Gastroenterology
• Infectious Diseases
• Surgical Pathology

Background:

• A middle-aged, HIV-positive male presented with peritonitis.
• The patient had two rare, sequential conditions: ileosigmoid knot and intra-abdominal mucormycosis.

Purpose of the Study:

• To report a rare case of sequential ileosigmoid knot and intra-abdominal mucormycosis in an HIV-positive individual.
• To highlight the complex surgical management and poor prognosis associated with these rare conditions.

Main Methods:

• Initial laparotomy for peritonitis revealed and resected a gangrenous sigmoid volvulus with ileosigmoid knot.
• Subsequent surgeries included restoration of colo-rectal continuity, distal ileum stapling, end jejunostomy, total gastrectomy, splenectomy, and repair of an oesophago-jejunostomy bile leak.

Main Results:

• The patient underwent multiple complex surgical procedures over a 19-day period.
• Despite aggressive surgical management, the patient's condition deteriorated.
• The patient ultimately died of multiple organ failure.

Conclusions:

• The simultaneous occurrence of ileosigmoid knot and intra-abdominal mucormycosis is exceptionally rare.
• This case underscores the challenges in managing critically ill patients with advanced HIV and severe intra-abdominal pathology.
• Aggressive surgical intervention did not prevent a fatal outcome in this complex case.