AN UNUSUAL VOLVULUS - THE ILEOSIGMOID KNOT

Abstract

INTRODUCTION Ileosigmoid knotting (ISK) is a rare entity which needs prompt recognition and immediate surgical intervention to avoid catastrophic complications caused by gangrenous bowel and subsequent peritonitis in a short span of time. Preoperative investigations are only diagnostic of intestinal obstruction and CT findings may be helpful. PRESENTATION OF CASE This case report  describes a 50 year old male presenting with acute abdomen managed with emergency laparotomy in view of findings of acute intestinal obstruction. Intra-operatively an ileal segment was wrapped around the base of sigmoid colon with  gangrenous ileal segment suggesting ISK. Resection of 2 feet of gangrenous ileal segment with primary end to side  anastomosis of ileum to ascending colon done. Patient tolerated procedure well. DISCUSSION Patients with  ileosigmoid knotting present with frank obstruction and require immediate medical and surgical treatment. This condition rapidly progresses to gangrenous bowel, generalized  peritonitis and sepsis with very high mortality. CONCLUSION Early diagnosis, prompt fluid resuscitation, preoperative antibiotics and immediate surgical exploration are keys for optimal management of this condition.