Ileosigmoid knotting in pregnancy

Abstract

Aim: Ileosigmoid knotting (ISK) is a rare event in pregnancy. This study reviewed the clinical outcomes of 3 pregnant patients with ISK and compared the characteristics of these pregnant women with 16 nonpregnant women. Materials and methods: The clinical records were reviewed retrospectively. Results: Three pregnant patients accounted for 4.2% of 72 total ISK patients and 15.8% of 19 female ISK patients. The ages of the patients were 35, 38, and 31 years (mean: 34.7 years). All of the patients were multiparous. Two patients (66.7%) were in the 3rd trimester and 1 (33.3%) was in the 2nd trimester. The mean duration of symptoms was 36.0 h. The main symptoms and signs were abdominal pain/tenderness, obstipation, and distention in all of the patients (100.0%), in addition to vomiting, hypo/akinetic bowel sounds and empty rectal vault in 2 (66.7%) and hyperkinetic bowel sounds, muscular guarding with rebound tenderness, and melenic stool in 1 (33.3%). Each patient had a preoperative diagnosis of mechanical intestinal obstruction, and all of the patients received emergency surgery. The outcomes were as follows: 33.3% maternal mortality, 66.7% fetal mortality, and 33.3% surgical morbidity. Conclusion: ISK in pregnancy is a rare occurrence. It is generally seen in multiparous women and in the 3rd trimester. Abdominal pain, distension, and obstipation are the main clinical features. An accurate diagnosis is difficult to obtain preoperatively, and patients are usually diagnosed with a nonspecific intestinal obstruction. After resuscitation, emergency surgery is needed. For gangrenous cases, resection of the ileum with primary anastomosis and resection of the sigmoid with colostomy are preferred, whereas detorsion is the treatment of choice for cases that are not complicated by gangrene. The prognosis of this disease is poor.