Recurrence in ileosigmoid knotting

Ileosigmoid knotting (ISK) is a rare but complicated form of ileum volvulus (IV) and sigmoid volvulus (SV). Our aim was to explore the recurrence of ISK, IV, and SV in cases with ISK.

The clinical data of Ataturk University, Faculty of Medicine, Department of General Surgery, were evaluated in a partial retrospective (from June 1966 to July 1986) and prospective (from July 1986 to January 2026) consideration. On the other hand, worldwide data were obtained from the last 81 years' literature (from 1945 to 2026) by electronic search of Web of Science and PubMed databases.

In 59.5-year period, we surgically treated 81 patients with ISK. Although we did not determine any ISK or IV recurrence, early and late SV recurrences were demonstrated in one for each (1.3%, one of living 79 patients and 4.5%, one of followed-up 22 patients, respectively). As worldwide data, early ISK, IV, and SV recurrences were determined one for each except for our one case with early SV recurrence, while no late recurrence was found among limited data. Primary surgery was detorsion alone in all above-mentioned recurrent cases.

Early ISK, IV, and SV recurrences are uncommon outcomes of ISK. However, long-term outcomes are controversial due to the insufficient data. The most important cause of recurrence was conservative surgery including detorsion alone. Emergency or elective definitive surgery including ileum resection or cecopexy (in cases elongated ileum or mobile cecum) and sigmoidopexy or sigmoid colectomy (in cases with sigmoid dolichocolon) may reduce ISK, IV, and SV recurrences in selected patients with ISK.