Case report on ileosigmoid knotting: a rare cause of intestinal obstruction

Ileosigmoid knotting involves the wrapping of an ileal loop around the base of the redundant sigmoid colon, and vice versa. In some African, Asian, and Middle Eastern countries, it is common; however, in the West, it is an uncommon entity.

A 70-year-old female patient presented with abdominal pain, distention, and failure to pass feces of 4 days' duration. She also had a history of two episodes of vomiting and failure to pass flatus of a day's duration. Vital signs were within normal limits. On abdominal examination, she had a grossly distended abdomen, was hyper-tympanic to percussion, and had hyperactive bowel sounds. On digital rectal examination, an empty rectum was noted, and no blood was found on the examining finger. Emergency exploratory laparotomy was performed, and the intraoperative findings revealed that both the ileum and sigmoid colon viable ileosigmoid knotting. Untying, and derotation were carried out. The patient was transferred to the surgical intensive care unit. Her follow-up was uneventful.

Ileosigmoid knotting is an uncommon cause of mechanical intestinal obstruction. For its etiology, it requires the unusual anatomical prerequisites of a movable small intestine with a long mesentery and a redundant sigmoid colon with an elongated, narrow-based mesentery. In less than 20% of individuals, ileosigmoid knotting is diagnosed prior to surgery. A plain abdominal X-ray may reveal disproportionate distension with air-fluid levels in the sigmoid colon.

Effective surgery, adequate antimicrobial therapy, aggressive preoperative resuscitation, and postoperative metabolic care all contribute to a lower incidence of morbidity and mortality.