A rare case report of ileosigmoid knots that cause intestinal obstruction during Ramadan fasting

This case report aims to highlight the clinical presentation, diagnostic challenges, surgical intervention, and subsequent management strategies of ISK during Ramadan fasting.

52-Year-old male with a three-day history of symptoms of intestinal obstruction. He complained of abdominal distention, vomiting, and absolute constipation. He had hypotension and tachycardia, as well as asymmetric abdominal distension. Laboratory investigations revealed a biological inflammatory syndrome and anemia. The abdominal CT scan showed significant aerated distension of the sigmoid colon. The sigmoid wall appeared to be dilated. Extra-digestive air bubbles were observed near the transition level, along with moderate intraperitoneal effusion. We found severe acute necrosis of the sigmoid colon and distal ileum, accompanied by a large volume of putrid ascitic fluid. The sigmoid was wrapped around the ilium. A Hartmann procedure was performed. The patient had an uneventful postoperative recovery.

ISK, also known as compound volvulus or double volvulus, is a rare and life-threatening intestinal obstruction caused by the twisting of the ileum and sigmoid colon around each other. The incidence of ISK is not known. The exact cause of ISK is unknown. Ingestion of heavy meals when the small intestine is empty. This may explain the high incidence during Ramadan. ISK is classified into four types according to the direction. This classification is more useful for predicting mortality and morbidity.

ISK is a rare cause of intestinal obstruction and intestinal ischemia. It is important to differentiate between the Knott ileosigmoid and the simple volvulus of the sigmoid to avoid morbidity.