Ileo-Ileal Knotting: A Rare Case of Bowel Strangulation

Intestinal knotting syndrome is a rare cause of bowel obstruction, and ileo-ileal knotting is the least common type. Prompt surgical management is required to prevent rapid clinical deterioration. We present the case of a 50-year-old woman from Mexico arriving at the emergency room with intense abdominal pain, accompanied by nausea, vomiting, and mild abdominal distention. An exploratory laparotomy was performed, with the finding of a true ileo-ileal knot with ischemic bowel compromise. The etiology of ileo-ileal knotting is not well described, and it has not been linked to a specific age or sex. The surgical approach could vary between untying the knot if the affected loop is still viable or performing a resection en bloc with anastomosis if there are signs of necrosis or gangrene. Intestinal knotting is a diagnostic challenge usually confirmed at the time of the surgery. Surgeons must be aware of ileo-ileal knotting as a differential diagnosis for acute abdomen in order to operate on time, know when a resection is needed, and the right technique to perform in these cases.