Ileosigmoid knotting: A case report of unique cause of acute abdomen in a Nepalese patient

Ileosigmoidal knotting: a case report and literature review of a rare cause of acute abdomen in children

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.

Ileostomy 101: Understanding the Basics for Optimal Patient Care

This comprehensive literature review explores the foundational aspects of ileostomy, encompassing surgical techniques, postoperative care, complications, and advancements. Ileostomy, a surgical procedure redirecting the ileal lumen through an abdominal opening, is a critical intervention for various gastrointestinal conditions. The review delves into surgical techniques, emphasizing the importance of stoma location and type selection, whether temporary or permanent. Complications associated with ileostomy are discussed, highlighting the significance of vigilant postoperative care, including stoma care and addressing potential complications. The profound impact of ileostomy on patients' quality of life is elucidated, underlining the necessity for a holistic approach to patient care. Additionally, advancements in the field, such as biodegradable stoma bags, smart stoma appliances, and telemedicine, are explored for their potential to enhance patient outcomes. The review emphasizes the need for individualized approaches and ongoing research to maximize the benefits of these advancements for ileostomy patients and improve their overall experience.

Pediatric Ileosigmoid Knotting: A Rare Culprit of Acute Abdominal Pain

The present study focuses on ileosigmoid knotting (ISK), an infrequent but potentially lethal surgical emergency. ISK is more frequently observed in males and is prevalent in regions with high rates of sigmoid volvulus. The current medical scenario revolves around the intricate intertwining of the ileum and sigmoid colon, leading to a complicated volvulus. This condition often results in acute intestinal obstruction, which can subsequently cause bowel necrosis. The clinical presentation of the condition is characterized by symptoms such as abdominal distention, pain, vomiting, and obstipation, which can be misleading as they are similar to other common abdominal conditions. A delay in definitive diagnosis and intervention is likely, which can lead to severe consequences such as peritonitis, bowel necrosis, sepsis, and even septic shock. Our case report discusses an instance of ISK presenting as an acute abdomen requiring an emergency laparotomy and detorsion of the volvulus-knotted segment, followed by an elective sigmoidectomy. The significance of a heightened level of suspicion, prompt decision-making, and timely surgical intervention in achieving better patient outcomes cannot be overstated. The objective is to enhance the medical community's understanding of ISK, focusing on early diagnosis and effective treatment of this rare but life-threatening disease.

Ileosigmoid Knotting: A Case Series

Ileosigmoid knotting is a rare case of intestinal obstruction that later leads to bowel necrosis. This is more common in males than females and seen more in areas with increased rates of sigmoid volvulus. The main clinical presentations are abdominal distention, abdominal pain and tenderness, vomiting, and obstipation. Definitive diagnosis is challenging due to its rarity and overlapping symptoms with other more common abdominal conditions. Delay in diagnosis and management can lead to peritonitis, necrosis of the bowel, sepsis, and eventually septic shock. Surgeons should consider ileosigmoid knotting in cases of acute abdomen, as it requires fast decision-making and intervention for a good prognosis. We present two cases of ileosigmoid knotting presenting with acute abdomen requiring emergent laparotomy with resection of necrotic bowel.

Ileo-sigmoid knotting- an unusual cause of intestinal obstruction: A case report

Introduction and importance

Ileosigmoid knotting is an unusual cause of intestinal obstruction in which the ileum wraps around the base of the sigmoid colon and its mesentery, which leads to a closed loop intestinal obstruction.

Presentation of case

A 59-year-old male patient was referred to our center with acute abdominal pain, obstipation and a few episodes of vomiting. On physical examination, he had hypotension and tachycardia as well as distension, diffused tenderness, guarding and rebound tenderness of the abdomen. Bowel sounds were absent. Abdominal Plain X-ray showed dilatation of the large bowel associated with the distended small bowel. After resuscitation with aggressive intravenous fluid therapy, the patient underwent an emergency laparotomy. Exploration revealed gangrene of the intestinal loops, including the jejunum and ileum, which was secondary to a 360° clockwise twisting of the ileal loops around the sigmoid colon. Gangrene of the sigmoid colon along with torsion of the superior mesenteric arteries was also obvious. Resection of the gangrenous loops of the small bowel as well as a sigmoidopexy was carried out and a primary anastomosis of the small intestine and colon was performed. He did well post-operatively.

Clinical discussion

It is crucial to distinguish Ileosigmoid knotting from sigmoid volvulus because it can rapidly, even within hours, progress to bowel gangrene and peritonitis; moreover, in this situation the endoscopic reduction is contraindicated.

Conclusion

Ileosegmoid knotting is an unusual cause of bowel obstruction which has relatively high mortality rates and should be considered in patients with acute abdominal pain and presentations of bowel obstruction.

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Ileosigmoid knotting is an unusual cause of intestinal obstruction.

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It is crucial to distinguish ISK from sigmoid volvulus because it can rapidly progress in to bowel gangrene and peritonitis.

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Due to confusing clinical and radiographic presentations of Ileosigmoid knotting, in most cases, making a precise diagnosis is not easy.