Ileosigmoid Knotting: Analysis of Patients Clinical Profiles and Determinants of Outcomes.

Kirubel Abebe,Henok Teshome,Kalid Sherefa,Engida Abebe

doi:10.1155/2020/3826138

Abstract

Introduction Ileosigmoid knotting (ISK) is an uncommon form of bowel obstruction due to wrapping of the ileum or sigmoid colon around the base of the other. It is associated with poor prognosis. Data on ISK are scarce in our country. The aim of this study was to assess clinical profiles, management, and outcome of patients operated for ISK. Methodology. A retrospective analysis of all patients operated for ISK at St. Paul's hospital millennium medical college (SPHMMC) from February 2014 to January 2020 was performed. Results A total of 28 patients (M: F = 3 : 1) were studied. The mean age was 41.7 years (SD ± 19.5) and ranged from 18 to 80 years. The mean duration of illness was 1.6 days (SD ± 1.1). Abdominal pain and vomiting were seen in all patients followed by abdominal distention (24, 85.7%) and failure to pass feces or flatus (23, 82.1%). Preoperative diagnosis was correct in 6 (21.4%) patients. Almost all patients (26, 92.8%) had gangrenous bowel. The commonest procedure performed was resection of the gangrenous segments with primary ileoileal anastomosis and sigmoid end colostomy (16, 57.1%). Complications were seen in 11 (39.3%) patients and the commonest being surgical site infection (SSI) (7, 25%). Death occurred in 6 (21.4%) patients, and it was significantly (p=0.020) associated with intraoperative shock (systolic blood pressure (SBP) < 90 mmHg). Conclusion ISK lacks specific clinical features and imposes a significant rate of bowel strangulation, which deserves high index of suspicion and urgent laparotomy. The choice of surgical procedure should be determined by intraoperative bowel status and patients' general condition.

Highlights

Ileosigmoid knotting (ISK) is an uncommon form of bowel obstruction due to wrapping of the ileum or sigmoid colon around the base of the other
Ileosigmoid knotting (ISK) is an uncommon etiology of intestinal obstruction due to wrapping of the ileum or sigmoid colon around the base of the other resulting in double closed loop bowel obstruction [1,2,3,4]. e incidence is not well-known, but it is commonly seen in parts of the world where there is a high incidence of sigmoid volvulus (SV)
A retrospective medical record review of all patients operated for ISK between February 2014 and January 2020 was performed at SPHMMC, Addis Ababa, Ethiopia, in May 2020

Summary

Introduction

Ileosigmoid knotting (ISK) is an uncommon form of bowel obstruction due to wrapping of the ileum or sigmoid colon around the base of the other. Ileosigmoid knotting (ISK) is an uncommon etiology of intestinal obstruction due to wrapping of the ileum or sigmoid colon around the base of the other resulting in double closed loop bowel obstruction [1,2,3,4]. E incidence is not well-known, but it is commonly seen in parts of the world where there is a high incidence of sigmoid volvulus (SV) It comprises around 18–50% and 5–8% of SV patients in Eastern and Western countries, respectively [4, 5]. A clinical picture of small bowel obstruction, radiographic evidence of large bowel obstruction, and inability to insert an endoscope has been proposed as a useful diagnostic triad of ISK [2, 15]

Methods

Results

Conclusion