A CASE OF ILEOSIGMOID KNOT FOLLOWING A GASTRECTOMY

Abstract

We experienced a case of ileosigmoid knot following a gastrectomy. A 69-year-old man was seen at the hospital because of severe abdominal pain when he was already associated with severe peritoneal signs. There was a previous history of undergoing a gast rectomy for a gastric cancer. Abdominal Xp on left side decubitus revealed air fluid level formation in the duodenum and sigmoid colon. Abdominal CT scan showed a dilated sigmoid colon. Since the abdominal pain was so severe, an emergency operation was performed with a diagnosis of ileus combined intestinal necrosis. The small intestine involving about 1m became red in color and edematous. The small intestine was strangulated by the sigmod colon like it was wrapped due to counterclockwise volvulus of the sigmoid colon. When the colon was turned clockwise, the strangulation was relieved and then the circulation to the sigmoid colon and small in testine was restored. Both the colon and intestine were not resected. The clinical course was uneventful and the patient was discharged from the hospital on 21 st hospital day. Mechanisms of onset of ileosigmoid knot in clude an ingestion of large volume of foods in an empty stomach. In gast rectomized patients, the food retension ability of the stomach decreased and a large volume of food is liable to flow in the intestine at once that might cause the disease in this case.