Abstract
IntroductionIleo-sigmoid knotting (ISK) is a rare cause of bowel obstruction in which the ileum twists around the sigmoid colon. It is associated with rapid bowel gangrene and a high mortality rate. Little has been published about this condition in Kenya. The objective was to determine the presentation, management, and outcome of patients with ISK.MethodsA seven year (January 2008-December 2014) retrospective chart review of patients managed for ISK at Tenwek Hospital in Bomet, Kenya.ResultsA total of 61 cases were identified, with a mean age of 35.8 years (range 2-68), and mean symptom duration of 1.6 days (range 3 hours-7 days). Gangrene was noted to involve both the ileum and colon in 45 patients, the ileum only in 9 patients, and the sigmoid colon only in one. Resection and primary anastomosis was carried out in most cases of gangrenous ileum (48/54, 89%) and gangrenous sigmoid colon (34/46, 74%), while resection and stoma was performed in 8 patients with gangrenous colon. Death occurred in 7 (11.5%) patients due to severe sepsis and multisystem organ failure. Morbidities were noted in 15 (24.6%) patients, including surgical site infection (8, 13.1%), respiratory insufficiency (4, 6.6%), fascial dehiscence (3, 4.9%) and anastomotic leak (2, 3.2%). The mean duration of hospitalization was 8.3 days (range 1-26).ConclusionIn this review, though retrospective in nature, ISK was noted to have high rates of bowel gangrene. In the appropriate setting, resection and primary anastomosis can be safely carried out in most cases of gangrenous colon.
Highlights
Ileo-sigmoid knotting (ISK) is a rare cause of bowel obstruction in which the ileum twists around the sigmoid colon
Though early surgery is recommended, as ISK is associated with early bowel gangrene and a high mortality rate, most cases are diagnosed intra-operatively due to the rarity of this condition and nonspecific clinical, laboratory, and X-ray features [1, 3]
Rigid sigmoidoscopy was performed in four patients who presented with features of intestinal obstruction (IO), no peritonitis on examination and X-ray findings suggestive of sigmoid volvulus
Summary
Ileo-sigmoid knotting (ISK) is a rare cause of bowel obstruction in which the ileum twists around the sigmoid colon It is associated with rapid bowel gangrene and a high mortality rate. Ileo-sigmoid knotting (ISK) is a rare cause of acute intestinal obstruction [1,2,3] that occurs when a loop of ileum wraps around the base of a redundant sigmoid colon [3,4,5] This condition is associated with high rates of gangrene involving the ileum, sigmoid colon, and at times, even extending to the caecum and ascending colon [3, 5]. The purpose of this study was to review the presentation, management, and outcome of patients with ISK
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