Abstract
Ileosigmoid knotting (ISK) is the wrapping of the ileum or sigmoid colon around the base of the other structure, causing a double-loop intestinal obstruction. The disease generally presents as an intestinal obstruction with volvulus triad, including abdominal pain/tenderness, distention, and obstipation. Abdominal X-ray findings are not pathognomonic, and computerized tomography (CT) and magnetic resonance imaging (MRI) are more useful in the diagnosis. A patient with ISK generally requires an emergency laparotomy following resuscitation. Based on the viability of the ileum and sigmoid colon, different resectional or non-resectional surgical techniques may be used. In this report, one of the largest single-center ISK series in the world, an eighty-case series, is concisely presented.
Highlights
Ileosigmoid knotting (ISK), the wrapping of the ileum or sigmoid colon around the base of the other structure, is an uncommon disease worldwide.[1,2] As of 2018, less than 500 cases have been reported in the literature.[3,4] Interestingly, the incidence of ISK is relatively high in eastern Anatolia,[5,6,7] where our university clinic is located
In patients with a gangrenous sigmoid colon, colostomy was applied in 6 patients, and primary anastomosis was applied in one following the resection
After the resection, ileal primary anastomosis with colostomy was used in 38 patients, sigmoid primary anastomosis with ileostomy in three, and double segment stoma in three
Summary
ISK, the wrapping of the ileum or sigmoid colon around the base of the other structure, is an uncommon disease worldwide.[1,2] As of 2018, less than 500 cases have been reported in the literature.[3,4] Interestingly, the incidence of ISK is relatively high in eastern Anatolia,[5,6,7] where our university clinic is located. Plain abdominal X-ray findings, including a dilated sigmoid colon with multiple intestinal air-fluid levels, were observed in only 7.0% of patients. Including whirled and knotted sigmoid colon and terminal ileum mesenteries with a dilated sigmoid colon and multiple intestinal air-fluid levels, were observed in 100.0% (9/9 and 3/3, respectively) of patients. Bowels were viable in 19 patients (23.8%) and gangrenous in the remaining 61 (76.3%), including ileum gangrene in eight, sigmoid colon gangrene in seven, and doublesegment gangrene in 46. In patients with a gangrenous sigmoid colon, colostomy was applied in 6 patients, and primary anastomosis was applied in one following the resection. After the resection, ileal primary anastomosis with colostomy was used in 38 patients, sigmoid primary anastomosis with ileostomy in three, and double segment stoma in three. The morbidity was 20.0% with the highest morbidity rate in the same group (28.3%)
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