Ileosigmoid knotting in early pregnancy: a case report

Ileosigmoid knotting (ISK) is a rare cause of intestinal obstruction, occurring when the ileum wraps around the colon and its mesentery. Its occurrence during pregnancy, especially before the third trimester, is extremely uncommon.

A 31-year-old woman at 12 weeks' gestation presented with 1 day of acute, severe abdominal pain, obstipation, vomiting, and abdominal distention. Physical examination revealed abdominal distention and severe rebound tenderness. Abdominal ultrasound showed a viable 12-week singleton pregnancy, colonic wall thickening, and free intraperitoneal fluid. Intraoperatively, an ileosigmoid knot was identified, with gangrenous changes affecting 150 cm of ileum and the sigmoid colon. The necrotic bowel was resected, with primary ileo-ileal anastomosis and a descending end colostomy. Postoperatively, the patient remained stable, and the fetus was viable.

ISK is a rare but life-threatening cause of intestinal obstruction. Imaging studies, including plain abdominal X-ray and non-contrast CT scan, can aid diagnosis, but definitive diagnosis is typically made intraoperatively. Prompt surgical intervention is essential because the condition can rapidly progress to gangrene, peritonitis, septic shock, and death.

This case highlights the importance of maintaining a high index of suspicion for intestinal obstruction in pregnant patients and demonstrates the critical impact of timely surgical management on favorable maternal and fetal outcomes.