1
|
Yadav DK, Shah SK, Poudel S, Parajuli B, Bhattarai A, Adhikari D. Ileosigmoidal knotting: a case report and literature review of a rare cause of acute abdomen in children. J Surg Case Rep 2024; 2024:rjae142. [PMID: 38476453 PMCID: PMC10930186 DOI: 10.1093/jscr/rjae142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Accepted: 02/18/2023] [Indexed: 03/14/2024] Open
Abstract
Ileosigmoidal knotting (ISK) is a rare, possibly fatal cause of intestinal obstruction. ISK is a compound volvulus that is more common in Africa and Asia. ISK is mostly seen in adults, pediatric cases reported in the literature are much rarer. In this report, we present the first reported case of ISK in a pediatric patient from Nepal. An 8-year-old male child presented with symptoms of abdominal pain, vomiting, and obstipation. The abdomen was distended with generalized tenderness. Erect abdominal X-ray showed multiple air-fluid levels. Intraoperatively, gangrenous ileum loops were entangled around the sigmoid, and resection of the gangrenous ileum and sigmoid was performed. An end-to-end colo-colic anastomosis from the descending colon to the remaining sigmoid with a double-loop ileostomy was performed. Pediatric ISK is a rare fatal form of intestinal obstruction that progresses quickly to gangrene. Clinical signs and symptoms are nonspecific, making preoperative diagnosis challenging.
Collapse
Affiliation(s)
- Dipak K Yadav
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| | - Sanjay K Shah
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| | - Saurav Poudel
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| | - Bivusha Parajuli
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| | - Amit Bhattarai
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| | - Dinesh Adhikari
- Department of General Surgery, Nobel Medical College Teaching Hospital, Kanchanbari, Biratnagar-4, Morang 56613, Nepal
| |
Collapse
|
2
|
Mohammed M, Wondimu B, Abera E. A rare case report of viable ileo-ileal knotting of acute abdomen in adults. Int J Surg Case Rep 2023; 106:108285. [PMID: 37148727 DOI: 10.1016/j.ijscr.2023.108285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/08/2023] Open
Abstract
INTRODUCTION Regardless of the cause, bowel obstruction is described as the absence of abnormal transit of intestinal contents. It may involve only the small intestine, the large intestine, or both. It might be brought on by a bodily impediment or widespread modifications to the metabolism, electrolyte balance, or neuroregulatory systems. In the field of general surgery, there are several well-known causes that can vary between developing and developed nations. CASE PRESENTATION In this case report, we describe a case of acute small bowel obstruction secondary to ileo-ileal knotting in 35 years old female patient with a complaint of crampy abdominal pain of 7 hour duration. She had associated frequent vomiting of ingested matter followed by bilious matter. She had also mild abdominal distention. She had history of caesarian section delivery 3 times the last time was 4 months back. CLINICAL DISCUSSION Ileoileal knotting is a unique and rare clinical entity in which a loop of proximal ileum wrap around the distal part of ileum. The presentation includes abdominal pain and distension, vomiting, and obstipation. The majority of cases require resection and anastomosis or exteriorization of the affected segment, and management entails a high index of suspicion and emergent investigation. CONCLUSION We demonstrate an instance of ileo-ileal knotting to highlight the fact that it is an unusual intraoperative finding and, given the rarity of cases, should be taken into account in the alternative diagnosis of patients exhibiting SBO signs and symptoms.
Collapse
Affiliation(s)
- Million Mohammed
- Department of Surgery, School of Medicine, College of Medicine and Health Sciences, Wachemo University, P.O. Box 667, Hossana, Ethiopia
| | - Besufikad Wondimu
- Department of Surgery, School of Medicine, College of Medicine and Health Sciences, Wollega University, P.O. Box 395, Nekemite, Ethiopia
| | - Ermias Abera
- Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Wachemo University, P.O. Box 667, Hossana, Ethiopia.
| |
Collapse
|
3
|
Saeki I, Touge R, Kojima M, Kurihara S, Tani C. A case of strangulated intestinal obstruction due to ileo-ileal true knot: Peculiar computed tomography findings. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2023. [DOI: 10.1016/j.epsc.2023.102586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
|
4
|
Abstract
Ileosigmoid knotting (ISK) is an extremely rare double-loop bowel obstruction. ISK is treated by emergency surgery with a relatively poor prognosis. Although some classification methods have been developed for ISK to date, the most comprehensive method was defined in 2018. Then, some subjects concerning this issue were evaluated in the literature. The aim of this paper is to update the last classification method in light of both the evaluations in the literature and our clinical experience with 80 ISK cases, which is one of the largest published single-centre ISK series.
Collapse
Affiliation(s)
- Sabri Selcuk Atamanalp
- Prof. Sabri Selcuk Atamanalp, MD, Department of General Surgery, Faculty of Medicine, Ataturk University, 25040, Erzurum, Turkey
| |
Collapse
|
5
|
Ileosigmoid Knotting: Changing Trends Over 50 Years. Indian J Surg 2018. [DOI: 10.1007/s12262-017-1636-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
6
|
Sigmoid volvulus: A pediatric case report and review of management. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2016. [DOI: 10.1016/j.epsc.2016.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
7
|
Cakir M, Tekin A, Kucukkartallar T, Kartal A. Ileosigmoidal knotting, an unusual form of acute intestinal obstruction. Acute Med Surg 2015; 2:234-236. [PMID: 29123729 DOI: 10.1002/ams2.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 11/20/2014] [Indexed: 11/09/2022] Open
Abstract
Aim Ileosigmoidal knotting is an unusual form of acute intestinal obstruction characterized by closed-loop obstruction of both ileum and sigmoid colon. We present 36 cases of ileosigmoidal knotting. Methods A retrospective analysis was designed to examine preoperative, operative, and postoperative findings of the 36 patients with ileosigmoidal knotting who were surgically treated in Necmettin Erbakan University's Meram Medical Faculty (Konya, Turkey) throughout a 26-year period. Results The mean age was 55 (range, 47-61) years. The most common symptoms were abdominal pain, distention, obstipation, and vomiting, and the most common signs were abdominal tenderness and distention. The preoperative diagnosis was acute obstructed bowel in all patients. After resuscitation, all patients underwent emergency laparotomy. The most common type of ileosigmoidal knotting was type IA, in which the active ileum encircled the passive sigmoid in a clockwise manner. There was gangrene in both ileum and sigmoid colon in all patients. All ischemic bowels including ileum and sigmoid colon were resected and the continuity was carried out using primary anastomosis or Hartmann's procedure. Conclusions Ileosigmoidal knotting is a rare disease but its preoperative diagnosis is difficult. In cases of knotting there is no form of conservative treatment. Resective surgery is absolutely necessary.
Collapse
Affiliation(s)
- Murat Cakir
- Meram Medical Faculty Department of General Surgery Necmettin Erbakan University Konya Turkey
| | - Ahmet Tekin
- Meram Medical Faculty Department of General Surgery Necmettin Erbakan University Konya Turkey
| | - Tevfik Kucukkartallar
- Meram Medical Faculty Department of General Surgery Necmettin Erbakan University Konya Turkey
| | - Adil Kartal
- Meram Medical Faculty Department of General Surgery Necmettin Erbakan University Konya Turkey
| |
Collapse
|
8
|
Yazough I, Benhammane H, Morad O, Ossibi PE, Toughrai I, Laalim SA, Hassani IM, Mazaz K. A rare cause of intestinal obstruction: ileosigmoid knot. Pan Afr Med J 2015; 19:21. [PMID: 25584132 PMCID: PMC4286229 DOI: 10.11604/pamj.2014.19.21.3902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 03/28/2014] [Indexed: 11/17/2022] Open
Abstract
Intestinal obstruction is common surgical emergency; ileosigmoid knot is a rare cause of intestinal obstruction (a loop ileum and sigmoid colon twisted around each other in a knot). We recorded a three cases in HASSAN II hospital in the last 3 years.
Collapse
Affiliation(s)
- Issam Yazough
- Department of Surgery, Faculty of Medecine and Pharmacy in Fez, Univerity Sidi Mohammed Ben Abdellah, CHU Hassan II, Fez, Morocco
| | - Houssam Benhammane
- Department of Surgery, Faculty of Medecine and Pharmacy in Fez, Univerity Sidi Mohammed Ben Abdellah, CHU Hassan II, Fez, Morocco
| | - Oussaid Morad
- Department of Surgery, Faculty of Medecine and Pharmacy in Fez, Univerity Sidi Mohammed Ben Abdellah, CHU Hassan II, Fez, Morocco
| | - Pierlesky Elion Ossibi
- Department of Surgery, Faculty of Medecine and Pharmacy in Fez, Univerity Sidi Mohammed Ben Abdellah, CHU Hassan II, Fez, Morocco
| | - Imane Toughrai
- Department of Surgery, Faculty of Medecine and Pharmacy in Fez, Univerity Sidi Mohammed Ben Abdellah, CHU Hassan II, Fez, Morocco
| | - Said Ait Laalim
- Department of Surgery, Faculty of Medecine and Pharmacy in Fez, Univerity Sidi Mohammed Ben Abdellah, CHU Hassan II, Fez, Morocco
| | - Ibn Majdoub Hassani
- Department of Surgery, Faculty of Medecine and Pharmacy in Fez, Univerity Sidi Mohammed Ben Abdellah, CHU Hassan II, Fez, Morocco
| | - Khalid Mazaz
- Department of Surgery, Faculty of Medecine and Pharmacy in Fez, Univerity Sidi Mohammed Ben Abdellah, CHU Hassan II, Fez, Morocco
| |
Collapse
|
9
|
Selçuk Atamanalp S. Treatment for ileosigmoid knotting: a single-center experience of 74 patients. Tech Coloproctol 2013; 18:233-7. [PMID: 23839796 DOI: 10.1007/s10151-013-1046-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Accepted: 06/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ileosigmoid knotting (ISK) is the wrapping of the ileum around the base of the sigmoid colon. The purpose of this study was to investigate the outcomes for patients undergoing various treatments for ISK. METHODS The clinical records of 74 ISK patients, over 46.5 years, were reviewed retrospectively. RESULTS Emergency surgical procedures included resection with primary anastomosis or stoma for patients with gangrenous bowel segments, and detorsion or an additional definitive procedure for patients with viable bowel. Application of these procedures resulted in mortality rates of 0.0% in 14 patients with viable bowel, 12.5% in 8 patients with ileal gangrene, 14.3% in 7 patients with sigmoid colon gangrene, and 28.9% in 45 patients with double-segment gangrene. CONCLUSIONS The principal strategy in the treatment for ISK is early and effective resuscitation followed by emergency surgery, including untying the knot, excising the gangrenous bowel segment, restoring intestinal continuity by primary anastomosis if possible, and preventing recurrence in selected patients.
Collapse
Affiliation(s)
- S Selçuk Atamanalp
- Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey,
| |
Collapse
|
10
|
Atamanalp SS. Ileosigmoid knotting: clinical appearance of 73 cases over 45.5 years. ANZ J Surg 2012; 83:70-3. [PMID: 22882631 DOI: 10.1111/j.1445-2197.2012.06146.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND Ileosigmoid knotting (ISK) is the wrapping of the ileum around the base of the sigmoid colon. The aim of this study was to investigate the clinical outcomes of 73 patients with ISK over 45.5 years. METHODS The clinical records were reviewed retrospectively. RESULTS The age range was 7-92 years (mean 46.7 years), and 54 patients (74.0%) were male. Forty-two patients (57.5%) experienced shock. The symptom duration range was 12-120 h (mean 46.5 h). The most common clinical features were abdominal pain and tenderness in 73 patients (100.0%), obstipation in 72 patients (98.6%), distention in 70 patients (95.9%) and vomiting in 61 patients (83.6%). The rate of correct diagnosis was 4.1% when based on clinical and X-ray findings (3/73) and 100.0% when based on computed tomography or magnetic resonance imaging findings (4/4 and 2/2, respectively). The diagnosis of ISK was confirmed by surgery in all cases. CONCLUSION ISK is a rare disease that occurs most commonly in adult men. The disease is generally associated with shock, and the clinical features generally present as a mechanical bowel obstruction. Although X-rays may aid diagnosis, computed tomography and magnetic resonance imaging are more reliable diagnostic tools. However, the diagnosis is made at laparotomy in some cases.
Collapse
Affiliation(s)
- Sabri Selçuk Atamanalp
- Department of General Surgery, Faculty of Medicine, Atatürk University, Erzurum, Turkey.
| |
Collapse
|
11
|
Mandal A, Chandel V, Baig S. Ileosigmoid knot. Indian J Surg 2011; 74:136-42. [PMID: 23542502 DOI: 10.1007/s12262-011-0346-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 09/29/2011] [Indexed: 11/25/2022] Open
Abstract
Ileosigmoid knotting, also known as compound volvulus or double Volvulus, is a rare cause of acute intestinal obstruction. In this condition the ileum wraps around the base of the sigmoid colon and forms a knot. The condition is serious, generally progressing rapidly to gangrene of both ileum and sigmoid colon. Ileosigmoid knotting is an unusual entity in the West, but is comparatively common in certain African, Asian and Middle Eastern nations. Awareness of the condition is essential for prompt diagnosis and optimal management. This article will focus on the etiopathogenesis, presentation, diagnostic modalities, surgical interventions and outcome with review of articles and case reports published till date.
Collapse
Affiliation(s)
- Ajay Mandal
- Department of Surgical Gastroenterology, The Calcutta Medical Research Institute, Kolkata, India
| | | | | |
Collapse
|
12
|
Burrah R, Menon A, Pathan H, Ravikanth R, Kilpadi A. The ileosigmoid knot. Indian J Surg 2010; 72:140-2. [PMID: 23133227 DOI: 10.1007/s12262-010-0023-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2008] [Accepted: 07/28/2008] [Indexed: 11/26/2022] Open
Abstract
Ileosigmoid knot is rare yet life-threatening condition caused by acute double loop intestinal obstruction. Preoperative diagnosis is difficult and it is associated with high morbidity and mortality. We present one such patient we encountered and outline our management, and discuss the surgical options available.
Collapse
Affiliation(s)
- Rajaram Burrah
- Department of General Surgery, St Johns Medical College and Hospital, Bangalore, Karnataka 560034 India
| | | | | | | | | |
Collapse
|
13
|
El Bouhaddouti H, Lamrani J, Louchi A, El Yousfi M, Aqodad N, Benajah D, El Abkari M, Ibrahimi A. [Combined ileocecal and sigmoid colonic volvulus]. JOURNAL DE CHIRURGIE 2009; 146:495-496. [PMID: 19833332 DOI: 10.1016/j.jchir.2009.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- H El Bouhaddouti
- Service de chirurgie viscérale B, centre hospitalier universitaire Hassan II, Fès, Maroc.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Abstract
Ileosigmoid knotting, also known as compound volvulus or double volvulus, is a rare cause of intestinal obstruction. In this condition the ileum wraps around the base of the sigmoid colon and forms a knot. Ileosigmoid knotting is an unusual entity in the West, but is comparatively common in certain African, Asian and Middle Eastern nations. The condition is serious, generally progressing rapidly to gangrene. Awareness of the condition is essential for prompt diagnosis and optimal management. This report describes a case in a 60-year-old male and describes the management of this rare condition. An additional 280 recent cases in the English literature are reviewed as to etiopathogenesis, presentation, diagnostic modalities, surgical interventions and outcome.
Collapse
Affiliation(s)
- Norman O Machado
- Department of Surgery, Sultan Qaboos University Hospital, Muscat, Oman.
| |
Collapse
|
15
|
Islam J, Thomson SR, Tudor G, Khan Z, Mjoli M. Ileosigmoid knot complicated by gastric and splenic mucormycosis: a lethal combination. BMJ Case Rep 2009; 2009:bcr10.2008.1049. [PMID: 21686483 DOI: 10.1136/bcr.10.2008.1049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Two very rare conditions, ileosigmoid knot and intra-abdominal mucormycosis, occurred sequentially in a middle-aged HIV positive male.At laparotomy for peritonitis, a gangrenous sigmoid volvulus with ileosigmoid knot was resected; 2 days later, colo-rectal continuity was restored, the distal ileum stapled and an end jejunostomy fashioned.At re-laparotomy on day 15, necrotic stomach and spleen required a total gastrectomy and splenectomy. At reoperation 2 days later, a bile leak at the oesophago-jejunostomy site was repaired. Despite this intervention he continued to deteriorate and died of multiple organ failure 4 days later.
Collapse
Affiliation(s)
- Jahangirul Islam
- Edendale Hospital, Surgery, PO Box 1307, Hilton, 3245, South Africa
| | | | | | | | | |
Collapse
|
16
|
Gunawardena SA, A. Gunawardena GS. Acute large bowel obstruction due to Ascaris lumbricoides in a child from Sri Lanka. Trop Med Health 2008. [DOI: 10.2149/tmh.36.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|