Ileo-Ileal Knotting: A Rare Cause of Strangulated Small Bowel Obstruction

Small bowel obstruction is a common surgical emergency, but ileo-ileal knotting is an exceptionally rare cause in which two loops of ileum intertwine into a true knot, leading to strangulation. Preoperative diagnosis of ileo-ileal knotting is extremely challenging due to nonspecific clinical features, and most cases are identified only during emergency surgery. We present three cases of ileo-ileal knotting to illustrate varied precipitating factors, presentations, and diagnostic challenges associated with this condition. All patients underwent urgent exploratory laparotomy with resection of the knotted, nonviable bowel and primary anastomosis; each had an uneventful recovery and was discharged in good condition. Although rare, ileo-ileal knotting should be considered in the differential diagnosis of acute intestinal obstruction, especially in rapidly deteriorating patients with signs of strangulation, since prompt surgical intervention is essential to prevent a fatal outcome.