Background: Ileosigmoid knotting (ISK) is one of the rare causes of acute intestinal obstruction. It has a rapid course for forming gangrene. In this condition, the ileum and sigmoid colon wrap around each other, causing a knot and strangulation of both structures. ISK is extremely rare in North America most cases are reported in Asia and Africa. This is a surgical emergency and an attempt to relieve the obstruction must be done promptly. The management may range from a resection and anastomosis of the ileum and Sigmoid Colon, ileostomy and Hartmann's procedure depending on patients condition and gangrenous bowel segment. Method: It is a retrospective study. Data collection was done for three years from September 2018 to August 2021 in Bankura Sammilani Medical College and Hospital in the Department of General Surgery. Result: In our study 26 patients (M: F ratio 3:1) was identified with ileosigmoid knotting. The mean age of the patients are 43 years (SD+/- 13) in the study population. It more commonly affects males (76.92%) who are in the fourth decade of life. About fifty percent patients (53.84%) presented with shock (chi square test p value <0.05). The double segment gangrene (69.23%) is the most common presentation than single segment. The most of the patients was operated with ileal and sigmoid colon resection and ileostomy and colostomy. The septicemia (23.07%) is the most common cause of mortality in the study (chi square test p value <0.05). Conclusion: Ileosigmoid knotting is a rare cause of intestinal obstruction and bowel ischemia. So the early diagnosis and prompt surgical intervention in general includes bowel resection with ileostomy and or colostomy and or primary anastomosis. Keywords: Ileosigmoid knotting, volvulus, gangrene, ileostomy, Hartmann’s procedure.