An unusual synchronous ileosigmoid and ileoileal knotting: a case report.

Nikolaos Andromanakos,Alkiviadis Kostakis,Stamatis Pinis,Dimitrios Filippou

doi:10.1186/1752-1947-8-200

Nikolaos Andromanakos, Alkiviadis Kostakis + Show 2 more

Open Access

https://doi.org/10.1186/1752-1947-8-200

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Abstract

IntroductionIleosigmoid and ileoileal knotting are two rare entities. They usually present as acute abdomen and the diagnosis is established intraoperatively. The treatment is surgical and should be performed as soon as possible to decrease the incidence of perioperative mortality and morbidity.Case presentationWe report an unusual case of a 26-year-old Argentine man with ischemic necrosis in parts of his small and large intestine due to combined ileosigmoid and ileoileal knotting. He had an ileal loop of ileum concurrently wrapped around the neck of a sigmoid volvulus and other loops of ileum strangulating them, forming two different tangles of tying. This very rare and unusual entity was diagnosed and managed intraoperatively during a diagnostic laparotomy performed on an emergency basis. Both the gangrenous small bowel loops and the affected sigmoid colon area were resected. The continuation of the intestinal tract was restored by primary end-to-end anastomoses. The present case is unusual and to the best of our knowledge no similar cases of simultaneous ileosigmoid and ileoileal knotting have been described in the literature. The postoperative course of our patient was uneventful and he was discharged from the hospital on the 15th postoperative day. One year later he still remains without symptoms from his intestinal tract.ConclusionSimultaneous ileosigmoid and ileoileal knotting is a very rare entity that should be diagnosed and treated surgically on an emergency basis to minimize the high postoperative morbidity and mortality.

Highlights

Ileosigmoid and ileoileal knotting are two rare entities
Intestinal knotting is the obstruction of an intestinal segment with closed loop phenomenon secondary to knotting of the mesentery
They are characterized by the segments of the large and small intestine that are affected in this rare entity

Summary

Introduction

Intestinal knotting is the obstruction of an intestinal segment with closed loop phenomenon secondary to knotting of the mesentery. In ileosigmoid knotting the sigmoid colon forms the axis around which the small bowel loop encircles. He seemed to be severely ill and was presenting bradycardia (47 beats per minute) and mild tachypnea, while his body temperature and blood pressure were within the normal values His abdomen was moderately distended and he presented tenderness with rebound during palpation and rigidity of his abdominal wall. The findings were a large amount of bloody fluid and necrosis of an extended area of his small bowel and sigmoid colon His gangrenous sigmoid colon was distended in torsion surrounded by a loop of ileum strangulating it, forming a tangle of knotting. Afterwards, the necrotized loops of his ileum (about 150cm) and sigmoid colon were resected Both small and large intestine continuity were restored by primary end-to-end anastomosis.

Discussion

Conclusions