Closed loop intestinal obstruction secondary to Ileo-sigmoid knotting (ISK) – A diagnostic challenge

Abstract

Intestinal obstruction due to Ileo-sigmoid knotting is a very rare phenomenon associated with high mortality rate leading to bowel gangrene and peritonitis. We present a rare cause of closed loop intestinal obstruction in a 46-year-old male patient who presented to the emergency department with complaints of severe abdominal pain, distension and multiple episodes of vomiting in the past 1 day. Prompt resuscitation and exploratory laparotomy revealed knotting of the sigmoid colon around the mesentery of small intestine with segmental gangrene of both sigmoid colon and small intestine. Resection of the gangrenous ileal segment with end-to-end anastomosis followed by Hartman’s procedure to the gangrenous sigmoid colon was performed. Ileo-sigmoid knotting is a surgical emergency with rapid progression to bowel gangrene and peritonitis leading to sepsis and has a very high mortality. Early diagnosis, fluid resuscitation and prompt surgical intervention are key steps towards management.