Strangulated bowel obstruction caused by an ileo-ileal knot: a rare case report

BACKGROUND

Intestinal knot formation is a condition wherein two segments of the intestine are knotted together; however, reports of small-intestinal ileo-ileal knot formation are rare.

CASE PRESENTATION

The patient was a 62-year-old Asian male with a history of endoscopic colorectal adenoma resection and a spontaneous pneumothorax. The patient had no history of a laparotomy. He consulted his local doctor with the chief complaint of abdominal pain and was admitted to our hospital with suspicion of an acute abdomen. The abdomen had muscular guarding with tenderness and rebound tenderness. Contrast-enhanced computed tomography (CT) showed torsion of the mesentery of the small intestine with poor contrast filling. The patient was referred to our department with strangulated bowel obstruction and underwent an emergency laparotomy. Intraoperative findings revealed that two segments of the ileum were wrapped around each other to form a knot, and the strangulated small bowel was necrotic. After the release of the knot, partial resection of the small intestine was performed from 220 cm distal to the ligament of Treitz to 80 cm proximal to the cecum. The patient had a good postoperative course and was discharged on the 11th postoperative day.

CONCLUSION

Ileo-ileal knots should be considered as part of the differential diagnosis when treating strangulated bowel obstruction.

Ileoileal knotting as a rare cause of acute abdomen in adolescents: Case report

INTRODUCTION

Knotting of bowel loops is a rare cause of acute abdomen and ileoileal knotting is one of the rarest causes, with only a few cases reported mostly in adult literature.

CASE PRESENTATION

We describe cases of ileoileal knotting in 13 and 12-year-old male and female adolescents who presented with crampy abdominal pain, distension, and episodes of vomiting. Both had tachycardia and features of peritonitis. They were explored and gangrenous ileoileal knotting was found. After the knot was disentangled, the gangrenous portion was resected, and ileoileal and ileo-ascending anastomosis were performed respectively. After a smooth postoperative course, the patients were discharged home in good condition.

CLINICAL DISCUSSION

The etiopathogenesis of ileoileal knotting is unknown, but speculative mechanisms are proposed, such as loaded bowel with longer mesentery, vigorous peristalsis, and a single bulky meal. The presentation includes abdominal pain and distension, vomiting, and obstipation. Management involves a high index of suspicion and emergent exploration with the majority requiring resection and anastomosis or exteriorization of the involved segment.

CONCLUSION

We discuss these cases of Ileoileal knotting to emphasize that it is a usual intraoperative surprise given the paucity of cases. But sudden and severe abdominal pain and distension, and features of peritonitis in short duration may be considered clues for suspicion. Surgery is the mainstay of treatment and hence, the prognosis depends on early diagnosis and intervention as morbidity and mortality are very high because of the rapid progression to gangrene.