Features Of Shock Research Articles

Purpura Fulminans with Peripheral Gangrene in Severe Falciparum Malaria: A Case Series

Background: Purpura fulminans is an acute fatal illness consisting of septicaemia, shock, and disseminated intravascular coagulation, often manifesting with gangrene of the distal extremities and necrosis of skin. Purpura fulminans associated with severe malaria has rarely been reported among children. Case Report: Two cases of purpura fulminans with disseminated intravascular coagulation probably due to severe falciparum malaria, are presented from a tertiary health facility in Nigeria. Both cases were males, and were infants aged 6 and 7 months respectively. They presented with fever, seizures, loss of consciousness and features of shock and had associated peripheral gangrene which developed hours into admission. Investigations showed P. falciparum hyper-parasitemia and evidence of disseminated intravascular coagulation. No focus for sepsis was identified and there were no bacterial isolates from blood culture. The second child survived but was left with amputated digits and audiovisual deficits. Conclusion: The cases presented demonstrate that purpura fulminans can occur in children with severe malaria even in P. falciparum endemic settings.

Clinical profile and outcome of children with meningitis- a prospective observational study in tertiary health care centre in Chennai

Objective: To study the clinical profile of children admitted with meningitis Design: Prospective observational study Setting: Study was conducted in PICU of tertiary health care centre in Chennai Participants: All children less than 18 years of age with a diagnosis of meningitis for a two years period between 2017- 2018 were included in the study Methods: All children with suspected meningitis admitted in pediatric intensive care unit of the Institution from January 2017 to December 2018 were studied. The variables included were age, sex, religion, residence, nutritional status, etiology of meningitis, duration of hospital stay, requirement of mechanical ventilation. The status of the child at the time of presentation, presence of shock, bleeding manifestations, raised intra cranial tension, was noted. The presence of sequelae and treatment and follow up was also noted. The collected data were analyzed with suitable statistical methods. Statistical analysis: Data was entered into Microsoft excel data sheet and was analyzed using SPSS 22 version software. Categorical data was represented in the form of Frequencies and proportions. Chi-square test was used as test of significance for qualitative data. Continuous data was represented as mean and standard deviation .p value of <0.05 was considered as statistically significant. Results: A total of 4237 children were admitted in the hospital out of which 13 meningitis cases in the age group below eighteen years comprised the study population. 3 (23%) were infants, 4 (30.7%) were between 1- 3 years of age, remaining 6 were more than3 years of age. Among the cases, 5 (38.4%) children were male and 8 (61.5%) were female. Among them, majority were Hindu (75.42%) by religion and urban (58.11%) by residence. Majority were due to bacteria while 3 (23.07%) each were due to viral and tubercular meningitis. Out of them 1 (8%) child was undernourished who had tuberculous meningitis. Out of the 13 children who were admitted, only 7 (53.88%) children were completely immunized. The duration of hospital stay was more than 2 weeks for 6 (46.1%) children, out of whom 2 had tubercular meningitis. Antibiotics were given for all of them while 8 (61.5%) children were given steroids. 4 (30.7%) had features of raised Intra cranial tension, while none had features of shock or bleeding manifestation or thrombosis.2 (15.38%) children required mechanical ventilation. Out of the children,2 (15.38%) had sequelae in the form of hydrocephalus,2 (15.38%) had subdural abcess,1 (7.3%) facial nerve palsy and hydrocephalus and 1 (7.3%) had hemiparesis. CSF analysis was done for all of the children with meningitis, out of whom CSF PCR showed hemophilus influenza b for 3 (23.7%) children, Escherichia shigella for 1(7.3%) child, Pneumococcus species for 1(7.6%) child candida for 1 (8.3%) child, enterovirus and streptococcus bovis for 1 (8.3%) child each. Conclusion: Acute bacterial meningitis still remains a major cause of mortality and morbidity in children. Hemophilus influenza remains the main cause in pediatric age group.

CD52 inhibits Toll-like receptor activation of NF-κB and triggers apoptosis to suppress inflammation.

Soluble CD52 is a small glycoprotein that suppresses T-cell activation, but its effect on innate immune cell function is unknown. Here we demonstrate that soluble CD52 inhibits Toll-like receptor and tumor necrosis factor receptor signaling to limit activation of NF-κB and thereby suppress the production of inflammatory cytokines by macrophages, monocytes and dendritic cells. At higher concentrations, soluble CD52 depletes the short-lived pro-survival protein MCL-1, contributing to activation of the BH3-only proteins BAX and BAK to cause intrinsic apoptotic cell death. In vivo, administration of soluble CD52 suppresses lipopolysaccharide (LPS)-induced cytokine secretion and other features of endotoxic shock, whereas genetic deletion of CD52 exacerbates LPS responses. Thus, soluble CD52 exhibits broad immune suppressive effects that signify its potential as an immunotherapeutic agent.

First case report of Providencia Rettgeri neonatal sepsis

BackgroundProvidencia are gram negative motile rods and is a member of the Enterobacteriaceae family. It consists of five species, namely Providencia alcalifaciens, Providencia rustigianii, Providencia stuartii, Providencia rettgeri and Providencia heimbachae. These are opportunistic pathogens and leads to infections in immunocompromised host. Providencia rettgeri has been associated with the nosocomial infections of the urinary tract and infections of wounds, burns and blood. Providencia rettgeri is very rare cause of neonatal sepsis and we report first case of neonatal late onset sepsis secondary to it.Case presentationA term male infant presented on day 4 of post-natal life with the complaint of decreased appetite, fast respiration and lethargy. The clinical examination showed features of sepsis and shock with chest radiogram showing pneumonia. The infant was started on invasive ventilation, intravenous fluids, antibiotic and inotropes. The blood culture was suggestive of multi-drug resistant P. rettgeri. The antibiotics were changed according to organism antibiotic susceptibility pattern and infant gradually improved and was discharged successfully.ConclusionProvidencia rettgeri is a very rare organism to cause neonatal sepsis. The management involves early diagnosis, treatment with appropriate antibiotics and finding the source of infection.

Clinical profile and outcome of patients with severe sepsis treated in an intensive care unit in India

Sepsis is the leading cause of intensive care unit (ICU) admissions and is associated with high mortality. To identify the incidence, risk factors and outcome of patients with severe sepsis and septic shock. A prospective observational study was done in a multidisciplinary ICU over a period of 18 months. We included all adult patients admitted to ICU with features of severe sepsis and septic shock as per SCCM/ACCP guidelines. Data related to demography, co-existing illnesses, parameters to assess Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores, other relevant laboratory data, source of infection, organ failures and supportive measures given were recorded. Primary outcome data on mortality was collected and secondary outcome data on ventilator days, ICU length of stay (ALOS) and ventilator free days were recorded. A total of 1162 patients were screened and 356 patients had severe sepsis. Incidence of severe sepsis was 30.6% and mortality rate was 51.6%. APACHEII (23.37 ± 9.47) and SOFA (7.58 ± 4.05) scores at admission were high. Most common source of infection was from the respiratory tract (37.2%) followed by urinary tract (10.3%) and intra-abdominal (9.5%) infections. About 63% of patients required ventilator support, 25.5% of patients required vasopressor support despite adequate fluid resuscitation and one third of patients required renal replacement therapy (35.7%). Haematocrit, total leucocyte count, serum bilirubin and SOFA scores were significantly higher among non-survivors. Incidence of severe sepsis was high and was associated with a poor patient outcome in an ICU in India.

Pathophysiological features of rat hemorrhagic shock under high temperature conditions

Objective To investigate the pathophysiological features of rat hemorrhagic shock under high temperature conditions. Methods A total of 128 SD rats were assigned to high temperature group and normal temperature group according to the random number table, with 64 rats per group. Rats in high temperature group were pretreated at 34℃ for 12 h, and in normal temperature group were kept at 25℃. Hemorrhagic shock models in rats were produced by withdrawing 40% of the total blood volume via the femoral artery. Parameters of the two groups were measured including blood electrolytes (Na+ , K+ ), plasma osmotic pressure, liver function [aspartate aminotransferase (AST), alanine aminotransferase (ALT)], kidney function [creatinine (CREA)], arterial blood gases (pH, PO2 and PCO2) and cardiac function [heart rate (HR), cardiac output (CO), cardiac index (CI) and DO2]. Animal survival time and survival rate were detected. Results Before shock, high temperature group versus normal temperature group showed higher detections of Na+ concentration [(142.3±2.2)mmol/L ∶(139.1±1.5)mmol/L], plasma osmotic pressure [(304.8±4.7)mmol/L ∶(300.0±1.9)mmol/L], HR [(462±30)times/min ∶(402±44)times/min], CO [(0.892±0.190)L/min ∶(0.713±0.090)L/min] and CI [(0.0030±0.0006)L·min-1·cm-2 ∶(0.0023±0.0002)L·min-1·cm-2] (P<0.05). After shock, normal temperature group showed further increased concentrations of Na+ and K+ and significantly enhanced AST, ALT and CREA compared to normal temperature group (P<0.05). After shock, CO, CI and DO2 in high temperature group were decreased by 63%, 63% and 69% respectively compared to those before shock, but less decrease was observed in normal temperature group. Rat survival rate and survival time were significantly reduced in high temperature group compared to normal temperature group (P<0.05). Conclusion Pathophysiological changes of hemorrhagic shock in rats under high temperature are mainly manifested as impaired cardiac function, significantly increased concentrations of Na+ and K+ and significantly shortened survival time. Key words: Hyperthermia, induced; Shock, hemorrhagic; Homeostasis

Efficacy of intraoperative transesophageal echocardiography in a case of protamine shock during transcatheter aortic valve implantation.

Here, we report the case of a patient who developed protamine shock during a transcatheter aortic valve implant (TAVI) procedure, which was diagnosed by intraoperative transesophageal echocardiography (TEE). A 77-year-old man with symptomatic severe aortic stenosis and reduced left ventricular (LV) function underwent TAVI under general anesthesia. During the procedure, a transcatheter heart valve (THV) was deployed via the transfemoral approach, without any other major complications. The entire device system was then removed, and protamine sulfate was administered intravenously in 2 min.Two minutes after the protamine administration, severe hypotension occurred. TEE did not reveal THV malfunction or any other major complications. However, comparison of the TEE image obtained before protamine administration and that obtained 2 min after protamine administration showed right ventricular (RV) dilatation, RV free wall motion abnormality, and LV volume reduction, without any electrocardiographic changes. We diagnosed this as protamine shock and bolus infusions of phenylephrine and norepinephrine were administered, and chest compressions were initiated immediately. After 1 min, hypotension as well as the right and left ventricular size and dysfunction immediately reverted to baseline. The severe systemic hypotension resolved as well. Thereafter, he recovered from anesthesia without other complications.This case showed the clinical features of protamine shock with acute pulmonary hypertension. The TEE images, in this case, should be a reminder for all doctors who perform intraoperative TEE for patient monitoring when they perform procedures to treat structural heart diseases.Electronic supplementary materialThe online version of this article (doi:10.1186/s40981-016-0053-6) contains supplementary material, which is available to authorized users.

A Correlation of the Platelet Count with D-Dimer Levels as an Indicator for Component Therapy in Children with Dengue Hemorrhagic Fever.

Dengue Fever (DF) may evolve into two life threatening forms-Dengue Hemorrhagic Fever (DHF) and Dengue Shock Syndrome (DSS). DHF is associated with increased vascular permeability and plasma leakage causing thrombocytopenia and loss of clotting factors into the third space and may result in bleeding initially due to thrombocytopenia and later due to disseminated intravascular coagulation (DIC), often as a terminal event. Prompt recognition and treatment of minor bleeds in DF children with incipient DIC with component therapy may be associated with improved survival while failure to do so is usually catastrophic. A sensitive marker for early DIC is the presence of D-dimer (DD) in the blood. To determine the correlation between the severity of thrombocytopenia and early DIC in children with DHF. The impact of additional factors like age and shock will also be evaluated. Case control prospective study of 60 DHF sero -positive children (1-15years) with thrombocytopenia. After clinical evaluation they were divided into two equal groups based on the degree of thrombocytopenia (more than/less than 30,000/mm3). PT/APTT and DD levels were estimated in all children of both groups and statistical correlation was done. There was no significant difference in the DD levels between the two groups. However, children in either group, presenting with clinical features of shock and thrombocytopenia had significantly higher DD levels. Empirical component therapy in children with DHF based purely on their low platelet counts may not be justified. However, in DHF children with thrombocytopenia and features of shock, aggressive component therapy may prevent subsequent bleeding and may be justified.

Impact of the Timing of Morphine Administration on Lipopolysaccharide-Mediated Lethal Endotoxic Shock in Mice.

Sepsis is a serious condition related to systemic inflammation, organ dysfunction, and organ failure. It is a subset of the cytokine storm caused by dysregulation of cytokine production. Morphine influences the severity of infection in vivo and in vitro because it regulates cytokine production. We investigated the immunological function of morphine using a mouse model of septic shock. We treated mice with α-galactosylceramide (2 μg/mouse) to induce lethal endotoxic shock following a challenge with lipopolysaccharide (LPS, 1.5 μg/mouse). This model represents acute lung injury and respiratory failure, and reflects the clinical features of severe septic shock. We evaluated the effect of the timing of morphine (0.8 mg/mouse) administration on the survival rate, cytokine production in vivo, and histological changes of mice with LPS-mediated lethal endotoxic shock. Morphine treatment before LPS challenge suppressed lethal endotoxic shock. In contrast, when we administered after LPS, morphine exacerbated lethal endotoxic shock; hematoxylin and eosin staining revealed a marked increase in the accumulation of infiltrates comprising polymorphonuclear leukocytes and mononuclear cells in the lung; and Elastica van Gieson staining revealed the destruction of alveoli. The plasma levels of tumor necrosis factor-α, interferon-γ, monocyte-chemotactic protein-1, and interleukin-12 in the group treated with morphine after LPS challenge were higher than those treated with morphine before LPS challenge. In conclusion, one of the factors that determine whether morphine exacerbates or inhibits infection is the timing of its administration. Morphine treatment before shock improved the survival rate, and morphine treatment after shock decreased the rate of survival.

The nature and energetics of AGN-driven perturbations in the hot gas in the Perseus Cluster

Cores of relaxed galaxy clusters are often disturbed by AGN. Their Chandra observations revealed a wealth of structures induced by shocks, subsonic gas motions, bubbles of relativistic plasma, etc. In this paper, we determine the nature and energy content of gas fluctuations in the Perseus core by probing statistical properties of emissivity fluctuations imprinted in the soft- and hard-band X-ray images. About 80 per cent of the total variance of perturbations on ~ 8-70 kpc scales in the inner region have an isobaric nature, i.e., are consistent with slow displacements of the gas in pressure equilibrium with ambient medium. Observed variance translates to the ratio of non-thermal to thermal energy of ~13 per cent. In the region dominated by weak "ripples", about half of the total variance is also associated with isobaric perturbations on scales ~ a few tens of kpc. If these isobaric perturbations are induced by buoyantly rising bubbles, then these results suggest that most of the AGN-injected energy should first go into bubbles rather than into shocks. Using simulations of a shock propagating through the Perseus atmosphere, we found that models reproducing the observed features of a central shock have more than 50 per cent of the AGN-injected energy associated with the bubble enthalpy and only about 20 per cent is carried away with the shock. Such energy partition is consistent with the AGN-feedback model, mediated by bubbles of relativistic plasma, and supports the importance of turbulence in the balance between gas heating and radiative cooling.

Cervical ectopic pregnancy-a maternal near miss case

Primary cervical pregnancy is a rare entity, the reported incidence being 1 in 8,600 to 12,400 and 1% of extrauterine pregnancies. A case of maternal near miss with cervical pregnancy in 29 yr old gravida three para two with previous caesarean section presented with bleeding per vagina followed by 16 weeks of amenorrhoea with severe pallor and features of hypovolaemic shock is described. Urine beta HCG test was positive. She was resuscitated and underwent laparotomy followed by total abdominal hysterectomy with bilateral ovaries preserved. Histopathological examination confirmed the diagnosis with features of endocervical trophoblastic invasion. A literature review discloses very few cases of cervical pregnancy. Early detection and prompt treatment can preserve the future fertility of the woman.

Diagnosis and management of acute pulmonary embolism. ESC guidelines 2014

Acute pulmonary embolism (PE) still represents a challenge regarding a rapid diagnosis and a risk-adapted therapy. In the 2014 guidelines of the European Society of Cardiology (ESC) on the diagnosis and management of acute PE, several new recommendations have been issued based on new study data. Some established scores for risk stratification were developed further and there is now good evidence for the use of age-adjusted D-dimer cut-off levels. For the risk stratification in patients without clinical features of shock, the utilization of the pulmonary embolism severity index (PESI) and simplified PESI (sPESI) scores is recommended. In patients with intermediate risk, right ventricular morphology and function can be evaluated by computer tomography or echocardiography and biomarkers facilitate further risk stratification. For the treatment of patients with venous thromboembolism with or without PE, the non-vitamin K-dependent oral anticoagulants (NOACs) are a safe alternative to the standard anticoagulation regimen with heparin and vitamin K antagonists. Systemic thrombolytic therapy should be restricted to patients with high risk or intermediate high risk with hemodynamic instability. Finally, new recommendations for the diagnosis and therapy of patients with chronic thromboembolic pulmonary hypertension (CTEPH), with cancer or during pregnancy are given.

Gastric Gangrene Due to Acute Necrotizing Gastritis Secondary to Group A Streptococcus Bacteremia

Introduction: Acute necrotizing gastritis, a variant of phlegmonous gastritis is an extremely rare cause of gastric necrosis where major gastric vessels remain patent yet gastric gangrene occurs secondary to a necrobiotic infection. We present such a case secondary to Group A Streptococcal infection. Case Presentation: A 73 year-old-female with a history of polymyalgia rheumatica on chronic prednisone presents with one day history of retrosternal chest pain radiating to the back with associated nausea and non-bloody emesis. There was an antecedent two week history of sore throat with a severe post-nasal drip. On presentation, the patient was toxic appearing with features of septic shock. Cross sectional imaging reveals marked gastric wall thickening with patent gastric vasculature. Upper endoscopy defines areas of gastric ischemia with necrotic ulcerations on the lesser curvature (Figure 1). Exploratory laparotomy with distal gastrectomy demonstrates acute necrotizing gastritis with gastric wall gangrene; histopathology reveals numerous gram-positive cocci in chains (Figure 2, 3). Blood cultures were positive for Group A Streptococcus. There was no evidence of an underlying hypercoagulable or rheumatological disorder; an extensive infectious disease evaluation inclusive of TEE, CT chest and sinus, bronchoscopy, and thoracentesis was negative. The patient was successfully treated with penicillin.Figure 1Figure 2Figure 3Conclusion: This case highlights an atypical presentation of Group A Streptococcal pharyngitis with consequent gastric gangrene. There is scant literature regarding acute nectrotizing gastritis secondary to an inciting infectious etiology. Early recognition remains the cornerstone in mitigating against significant morbidity and mortality.

Clinical features and management of haemorrhagic shock.

This article discusses the clinical features of haemorrhagic shock and the strategies used to manage the condition, focusing on the presenting symptoms, classifications, compensatory mechanisms, physiological changes and nursing interventions. Haemorrhagic shock is a condition of reduced tissue perfusion as a result of the inadequate delivery of oxygen and nutrients necessary for cellular function. The condition is secondary to large-volume blood loss, often associated with trauma or complications following surgical or medical procedures. Identifying and stopping the source of the uncontrolled bleeding is essential. Because of the life-threatening nature of the condition, it is important that haemorrhagic shock is identified promptly and appropriate management is commenced without delay.

Linear and nonlinear heavy ion-acoustic waves in a strongly coupled plasma

A theoretical study on the propagation of linear and nonlinear heavy ion-acoustic (HIA) waves in an unmagnetized, collisionless, strongly coupled plasma system has been carried out. The plasma system is assumed to contain adiabatic positively charged inertial heavy ion fluids, nonextensive distributed electrons, and Maxwellian light ions. The normal mode analysis is used to study the linear behaviour. On the other hand, the well-known reductive perturbation technique is used to derive the nonlinear dynamical equations, namely, Burgers equation and Korteweg-de Vries (K-dV) equation. They are also numerically analyzed in order to investigate the basic features of shock and solitary waves. The adiabatic effects on the HIA shock and solitary waves propagating in such a strongly coupled plasma are taken into account. It has been observed that the roles of the adiabatic positively charged heavy ions, nonextensivity of electrons, and other plasma parameters arised in this investigation have significantly modified the basic features (viz., polarity, amplitude, width, etc.) of the HIA solitary/shock waves. The findings of our results obtained from this theoretical investigation may be useful in understanding the linear as well as nonlinear phenomena associated with the HIA waves both in space and laboratory plasmas.

Lethal BCG-osis, in the context of superficial urothelial bladder carcinoma, diagnosed in autopsy

Intra-vesicular Bacillus Calmette–Guérin (BCG) immuno-therapy is a cornerstone in the treatment of superficial bladder carcinoma. However, it can rarely cause BCG-osis, a systemic infection, potentially fatal. A case of a 73year old man, diagnosed with superficial urothelial bladder carcinoma five months ago, who died with clinical features of septic shock one day after BCG therapeutic maintenance infusion, is presented. The cause of death, BCG-osis, was revealed during autopsy.

Aluminium phosphide poisoning cases in a tertiary care hospital

Background: Aluminium phosphide is used to control rodents and pests in grain storage facilities. It produces phosphine gas, which is a mitochondrial poison. Unfortunately, there is no known antidote for aluminium phosphide intoxication and the mortality rate is very high. This type of poisoning (known as Kerry or Rice tablet poisoning) is common in Comilla region in Bangladesh. Methods: The study was an observational study and was conducted in the Department of Medicine and in Emergency Room of Comilla Medical College Hospital, Comilla, between February and August, 2013. Twenty five cases of Kerry tab. Poisoning were studied about their causes, clinical features, treatment and outcome. Results: Most of the patients (92%) were female and age range was 15-45 yrs. Familial disharmony was the main reason of their suicidal attempts. This poisoning was common in Chandina, Sadar, Debidar, Burichong, B.para, Muradnagar and Daudkandi upazillas of Comilla District. Vomiting and features of shock were the major clinical menifestations. Routine ECG was not done to these patients. Most of the patients (80%) were referred to higher centres in Dhaka after the primary management. Only 20% patients were survived due to early stomach wash and supporting medical management. One patient who survived also mentioned of taking date expired Kerry tablet. Conclusion: Strict implementation of nationwide pesticide regulation, including restricting the availability of poison, being aware of its toxicity and providing improved medical management and improved intensive care facilities can further reduce the mortality due to AlP toxicity as there is no antidote available presently. DOI: http://dx.doi.org/10.3329/jdmc.v23i1.22685 J Dhaka Medical College, Vol. 23, No.1, April, 2014, Page 3-6

Rudimentary Horn Pregnancy: A Rare First Trimester Acute Presentation

Introduction: Rudimentary horn pregnancy (RHP), an entity with a diagnostic dilemma is known to rupture most commonly in second trimester, sometimes in early third trimester. This case of ectopic rudimentary horn (RH) presented acutely in the first trimester. Case Presentation: A 30 years old G 3 P 2 L 2 with previous two vaginal deliveries presented with acute abdominal pain and features of hemorrhagic shock at 8 weeks 5 days gestational age. With clinical diagnosis of ruptured ectopic pregnancy, the patient immediately underwent laparotomy, which revealed hemoperitoneum with a unicornuate uterus along with ruptured RHP. RH excision with ipsilateral salpingectomy and right tubal ligation was done and the maternal life salvaged. Conclusion: High index of suspicion based on clinical history and examination complemented with diagnostic radiological modalities can help in prenatal and pre-rupture diagnosis of RHP, hence its prompt treatment to alleviate scope of any emergency

Boerhaave′s syndrome presented with right-sided hydropneumothorax and hoarseness of voice: A case report

Boerhaave's syndrome is a rare and sometimes life-threatening condition characterized by lower esophageal tear due to a sudden rise of intraluminal pressure, and it is usually presented with a history of forceful vomiting, abdominal or chest pain, and sometimes subcutaneous emphysema. Atypical and delayed presentation is also not uncommon. A high index of suspicion is needed for diagnosis. The diagnosis is confirmed by contrast esophagogram or contrast computed tomography (CT) of the chest. Mortality rates could be as high as nearly 20-40% even in the treated cases. In this article, we report a case of a 57-year-old male, who is a smoker as well as an alcoholic, with right-sided hydropneumothorax presenting with dyspnea, epigastric pain, hoarseness of voice, and features of shock. Boerhaave's syndrome was suspected on finding food particles in pleural fluid that contained very high salivary amylase level. The diagnosis was confirmed with a sterile methylene blue contrast study.

Atypical Presentation of Ileo-Sigmoid Knot: A Rare Case

Ileosigmoid knot, also known as compound volvulus, is an unusual and a rare cause of intestinal obstruction. We are reporting a case of ileosigmoid knot in a 25-year-old male, who presented with features of acute intestinal obstruction, peritonitis and hypovolemic shock. On immediate exploration after resuscitation, we found minimal haemorrhagic intraperitoneal fluid and gangrenous total colon, gangrenous distal ileal loop twisted around the base of the gangrenous sigmoid loop. Total colectomy with distal ilectomy (50 cms), Hartmann’s procedure with end ileostomy was done. After 3 months we performed ileorectal anastomosis.