Small bowel knots

INTRODUCTION

Intertwining of bowel loops to form a knot is very rare cause of intestinal obstruction. Among intestinal knots, ileoileal knotting is the most rare, with only a handful of cases reported in literature. We present a rare case of ileoileal knotting and review of small bowel knots. The aim of this review was to summarise the existing evidence on small bowel knots and to postulate the possible mechanisms for knotting.

METHODS

A systematic search was conducted for literature published up to December 2019 using MEDLINE, PubMed and Google Scholar databases, together with the references of the full-text articles retrieved. Papers with case reports of small bowel knots were considered to be eligible for inclusion in the review.

FINDINGS

A total of 14 case reports were evaluated. There was no clear predilection for age or sex. Mostly cases were from Asia and Africa with no cases from the West. The presenting complaints were abdominal pain (93%), vomiting (64%), abdominal distention (57 %) and obstipation (43%). The bowel was gangrenous in 78% of cases. All underwent exploration, with the majority requiring resection and anastomosis of the involved segment.

CONCLUSION

Ileoileal knotting is a very rare cause of intestinal obstruction. Possible mechanisms include loaded bowel with longer mesentery, vigorous peristalsis, single bulky meal, pregnancy and intussusception. The condition is extremely difficult to diagnose preoperatively and it is usually diagnosed intraoperatively. The standard of treatment is resection of gangrenous part and anastomosis.

Compound volvulus: a case report and literature review

Compound volvulus is an uncommon cause of acute abdomen and involves the twisting of the loops of ileum around the base of the sigmoid or vice versa. It is a surgical emergency that is often missed pre-operatively. We are reporting this case and reviewing the relevant literature to increase the awareness of this condition. A 37-year-old female presented at the Emergency Unit of our hospital with features thought to be acute peritonitis secondary to typhoid perforation and a differential of rupture appendix. She had laparotomy with the finding of a gangrenous twisted terminal ileum around the base of the sigmoid for which a right hemicolectomy and sigmoidopexy were done. Compound volvulus, though rare, can still be encountered in our environment. Prompt identification, adequate resuscitation and expedient intervention will reduce morbidity and mortality.

Treatment for ileosigmoid knotting: a single-center experience of 74 patients

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.

Ileosigmoid knotting: clinical appearance of 73 cases over 45.5 years

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.

Ileosigmoid knot

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.

Ileosigmoid knot: a case report and literature review of 280 cases

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.