Ileo-Ileal Knotting Presenting as Strangulated Small Bowel Obstruction: An Uncommon Surgical Catastrophe

Ileo-ileal knotting is an exceptionally rare cause of small bowel obstruction in which two ileal loops twist around each other, resulting in vascular compromise and bowel strangulation. Preoperative diagnosis is difficult because of non-specific clinical and radiological findings, and most cases are diagnosed intraoperatively. Delay in treatment may rapidly progress to bowel ischemia and gangrene. We report the case of a 78-year-old male patient who presented with acute intestinal obstruction. Contrast-enhanced computed tomography suggested closed-loop small bowel obstruction without definitive evidence of intestinal knotting. Emergency exploratory laparotomy revealed ileo-ileal knotting with gangrene involving approximately three feet of terminal ileum. Resection of the gangrenous bowel with double-barrel ileostomy was performed successfully. This case highlights the importance of early surgical exploration in rapidly progressive bowel obstruction and emphasizes intestinal knotting as a rare but important differential diagnosis of strangulated obstruction.