Ileosigmoid knot in pregnancy, incidentally discovered during caesarean section. A rare case report

The occurrence of intestinal obstruction during pregnancy is an unusual condition. Ileosigmoid knot is even rarer but it is associated with a poor prognosis.

We report a case of ileosigmoid knot in a 22-year-old patient who admitted to our department with third-trimester metrorrhagia in 36-week pregnancy. Ileosigmoid knot was incidentally discovered during a caesarean section indicated for retroplacental hematoma. Intraoperatively, necrosis of the ileum and the sigmoid colon was noted. After extraction of a healthy living male newborn, we performed resection of 30 cm of involved small bowel as well as resection of the necrotic sigmoid colon. We proceeded to do primary ileal anastomosis and a Hartmann's colostomy. The patient had a closure of colostomy after 30 days from the day of discharge, according to our department's protocol. The outcome was uneventful, with return to daily activities and a good maternal and perinatal prognosis.

Through the analysis of this case report, we discuss the etiopathogenic, diagnostic, therapeutic and prognosis aspects of ileosigmoid knot in pregnancy.

Ileosigmoid knot in pregnancy is a life threatening condition needing multidisciplinary management. It may be associated with other obstetric emergencies such as retroplacental hematoma, which is a diagnostic pitfall. The diagnosis is often an incidentally discovery as evidenced by this case report.