Ileosigmoid Knotting Research Articles

Ileosigmoid Knotting, Rare Cause of Intestinal Obstruction and Gangrene

Ileosigmoid Knotting, Rare Cause of Intestinal Obstruction and Gangrene

Les Occlusions Intestinales Par Nœud Ileo-Sigmoïdien : Aspects Diagnostiques, Thérapeutiques Et Pronostiques

Introduction: Ileosigmoid knot (ISK), also known as compound volvulus or double volvulus, is a rare disease and affects mostly male subjects in their fourth decade. Delayed diagnosis often leads to complications with a high incidence of digestive necrosis. Materials and methods: This was a 10-year retrospective, descriptive and analytical study from 1 January 2007 to 31 December 2016, which covered all patients operated emergently for ISK in the surgical and surgical specialty departments at the Niamey National Hospital (NNH). Results: The series involved 8 cases of ISK, representing 0.82% of intestinal obstructions. There were 7 men and 1 woman. The average age of patients was 44.33 years with extremes ranging from 25 to 60 years. The main clinical signs were: abdominal pain (100%), inability to pass gas and stool (100%), vomiting (87.5%) and abdominal meteorism (87.5%). Four patients (50%) had a clear obstructive syndrome and the other 4 patients (50%) had associated signs of peritoneal irritation. Paraclinical diagnosis was difficult because of atypical clinico-radiological signs, but in all cases an abdominal x-ray was performed and showed a double loop of dilated sigmoid shadow in 87.5% of the cases. Laparotomy was the first approach used in all patients and led to a 50% necrosis rate. Hartmann’s colectomy and ideal colectomy were used in identical proportions, with 50% each. Ideal colectomy was characterized by a morbidity rate of 50% and a mortality rate of 25% compared to 0% for Hartmann’s procedure. The overall morbidity was 25% and the overall mortality was 12.5%. The average hospital stay was 65.87 days (range 17 to 128 days). The average time before reestablishment of digestive continuity was 50.37 days (range 31-128 days). Conclusion: Ileosigmoid knot is a rare condition at Niamey national hospital where the diagnostic approach is similar to that of occlusions in general, but remains difficult due to its uncommonness and atypical clinico-radiological signs. Necrosis rates and postoperative complications remain high.

Ileosigmoid Knotting: Changing Trends Over 50 Years

Ileosigmoid knotting (ISK) is the wrapping of ileum and sigmoid colon around each other. The purpose is to evaluate the changes in incidence, treatment, and outcomes over several decades to the present. The clinical records of 78 patients over the last 50 years were reviewed retrospectively until June 1986, and prospectively thereafter, and the results of the first and last 25 years were compared. The incidence of ISK decreased during the reviewed 50-year period (p 0.05 for each), the typical symptomatic period shortened (p 0.05), but the preoperative diagnostic accuracy rate increased (p 0.05 for each). The predominant surgical treatment was modified, as resection with primary anastomosis generally took the place of resection with stoma for both ileum (p 0.05 for each), though the average hospitalization period shortened (p < 0.05). As a result, over time, we found a decrease in the incidence of ISK as well as some changes in the diagnostic and therapeutic strategies, although the clinical features and prognosis did not change.

Ileosigmoid Knotting: An Unusual Cause of Intestinal Obstruction

Ileosigmoid knot or double volvulus is an unusual cause of intestinal obstruction and presents as a surgical emergency. It affects m sigmoid loops producing obstruction and strangulation. Here old male presented with features of intestinal obstruction. Emergency laparotomy revealed ileosigmoid knotting with gangrene of involved segment. Resection of unviable portion with knot was done with double primary anastomosis and covering ileostomy.

Factors Influencing Outcome of Sigmoid Volvulus in Northern Uganda. A Prospective Observational Study

Introduction: Sigmoid volvulus (SV) is one of the commonest causes of intestinal obstruction in Uganda. The purpose of this study was to determine the factors influencing the outcome of SV in Northern Uganda. Methodology: A prospective observational study was conducted on 103 sigmoid volvulus patients admitted between January 2012 to December 2012 and surgically managed in 19 hospitals in Northern Uganda and followed up postoperatively for 30 days. Surgical management was by resection and primary anastomosis or Hartmann’s procedure or double barrel colostomy. Patients 13 years and above with sigmoid volvulus and who had consented/Assented were included in the study and followed up to the 30th postoperative day. Ethical approval for the study was obtained from the Institutional Review Committee of Gulu University and Uganda National Council for Science and Technology. Data analysis was carried out using STATA/IC version 12.1. The outcome events were uneventful recovery, morbidity and mortality. Results: Eighteen(17.48%) patients developed complications including wound sepsis 10 (9.7%); wound dehiscence 8(7.7%) and anastomotic leak 8(7.7%). There were 8 deaths, giving a mortality rate of 7.7%. The factors associated with a high risk of adverse outcome were hypernatraemia (RR=14.9; 95% CI: 1.46-152.9) and ileo-sigmoid knotting (RR = 4.94; 95% CI: 1.30-18.78). Resection and primary anastomosis had a better outcome compared to Hartmann’s procedure (RR=0.15; 95% CI: 0.02-0.099). Conclusion: The risk factors associated with morbidity and mortality were preoperative hypernatraemia and ileo-sigmoid knotting. Colostomy was associated with a higher risk of morbidity and mortality than resection and primary anastomosis. Keywords : Sigmoid volvulus, factors, influence, outcome

Ileosigmoid knot which is a cause of acute abdomen at 28 week of pregnancy: A rare case report

Ileosigmoid knot which is a cause of acute abdomen at 28 week of pregnancy: A rare case report

Ileosigmoid Knotting: A Rare but Treacherous Cause of Closed Loop Obstruction

Ileosigmoid Knotting: A Rare but Treacherous Cause of Closed Loop Obstruction

Ileo-sigmoid knotting: a review of 61 cases in Kenya.

IntroductionIleo-sigmoid knotting (ISK) is a rare cause of bowel obstruction in which the ileum twists around the sigmoid colon. It is associated with rapid bowel gangrene and a high mortality rate. Little has been published about this condition in Kenya. The objective was to determine the presentation, management, and outcome of patients with ISK.MethodsA seven year (January 2008-December 2014) retrospective chart review of patients managed for ISK at Tenwek Hospital in Bomet, Kenya.ResultsA total of 61 cases were identified, with a mean age of 35.8 years (range 2-68), and mean symptom duration of 1.6 days (range 3 hours-7 days). Gangrene was noted to involve both the ileum and colon in 45 patients, the ileum only in 9 patients, and the sigmoid colon only in one. Resection and primary anastomosis was carried out in most cases of gangrenous ileum (48/54, 89%) and gangrenous sigmoid colon (34/46, 74%), while resection and stoma was performed in 8 patients with gangrenous colon. Death occurred in 7 (11.5%) patients due to severe sepsis and multisystem organ failure. Morbidities were noted in 15 (24.6%) patients, including surgical site infection (8, 13.1%), respiratory insufficiency (4, 6.6%), fascial dehiscence (3, 4.9%) and anastomotic leak (2, 3.2%). The mean duration of hospitalization was 8.3 days (range 1-26).ConclusionIn this review, though retrospective in nature, ISK was noted to have high rates of bowel gangrene. In the appropriate setting, resection and primary anastomosis can be safely carried out in most cases of gangrenous colon.

A Case of a Resected Ileosigmoid Knot in an Older Schizophrenic Patient

A Case of a Resected Ileosigmoid Knot in an Older Schizophrenic Patient

A knot in the gut: A paediatric post-mortem CT diagnosis

We present a case of a previously healthy, five month old boy who, after a short history of mild abdominal complaints died unexpectedly. In this case no parental permission for a conventional autopsy could be obtained on religious grounds, but a and post-mortem CT was consented to and performed. Based on the clinical evaluation combined with PMCT findings a probable cause of death, ileosigmoid knotting, could be established.

Sigmoid volvulus and ileo-sigmoid knotting: a five-year experience at a tertiary care hospital in Tanzania.

BackgroundSigmoid volvulus is a common cause of intestinal obstruction in developing countries where it affects relatively young people compared to developed countries. No prospective study has been done on this subject in Tanzania and Bugando Medical Centre in particular. This study describes in our region, the clinical presentation, management and outcome of sigmoid volvulus.MethodsThis was a descriptive prospective study of patients operated for sigmoid volvulus at Bugando Medical Centre from March 2009 to February 2014.ResultsA total of 146 patients (M: F = 5.1: 1) representing 14.2% of all cases of bowel obstruction were studied. The median age at presentation was 48 years. The disease significantly affected the older males compared with females (P = 0.012). The majority of the patients 102, (93.2%) presented acutely and had to undergo emergency surgical intervention, the rest were either sub-acute or chronic. Out of the 146 patients studied, 24 (16.4%) had ileo-sigmoid knotting. The majority of patients, 102(69.9%) were treated with resection and primary anastomosis, of which 63.0% were emergency cases. Colostomy was offered to 30.1% of cases. No patient had sigmoidoscopic derotation. Complications mainly surgical site infections were reported in 20.5% of cases. The overall median length of hospital stay was 14 days. Overall mortality rate was 17.1%. The main predictors of mortality were advanced age (>60 years), concomitant medical illness, late presentation (≥24 hours), presence of shock on admission and presence of gangrenous bowel (P < 0.001). The follow up of patients in this study was generally poor as more than half of patients were lost to follow up.ConclusionSigmoid volvulus is not uncommon in our setting and commonly affects males than females. Most of the patients presented acutely, requiring immediate resuscitation and surgical approach. Findings from this study suggest that in viable bowel, sigmoid resection and primary anastomosis is feasible as it may not adversely affect outcome. Temporary colostomy should be considered if the bowel is gangrenous or perforated. Early diagnosis and timely definitive treatment are essential in order to decrease the morbidity and mortality associated with this disease.

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.

Pattern of adult intestinal obstruction at Tenwek hospital, in south-western Kenya.

IntroductionAcute mechanical intestinal obstruction (IO) is one of the leading causes of surgical admissions in most emergency departments worldwide. The causes of IO vary significantly depending on geographical location. The aim of this study was to identify the etiology, management and outcomes of patients with acute mechanical IO presenting in south-western Kenya.MethodsA 4 year (November 2009–October 2013) retrospective review of all adult patients admitted with acute mechanical IO at Tenwek Hospital in Bomet, Kenya.ResultsA total of 303 male and 142 female patients, presented with acute mechanical IO during the study period. Mean patient age was 40.6 years (range 17-91), with peak incidence in those aged 31-40 years. The foremost signs and symptoms were abdominal pain (89.4%), abdominal tenderness (81.6%), vomiting (78%), abdominal distension (65.4%) and constipation (50.8%). Sigmoid volvulus (25.6%), adhesions (23.1%), small bowel volvulus (21.3%), and ileo-sigmoid knotting (8.5%) were the leading causes of IO. Laparotomy was undertaken in 361 (81.1%) cases, with bowel gangrene noted in 112 (30.4%). The overall morbidity and mortality rates were 15% and 4.5% respectively. Patients with gangrenous bowel at laparotomy had a higher morbidity rate (22.3% vs 9.6%, P=.001), a higher mortality rate (9.8% vs 3.2%, P=.02) and a longer duration of stay (9.9 days vs 7.6 days, P=.0001) compared to those with viable bowel.ConclusionThe most common causes of IO in this study were sigmoid volvulus, adhesions, small bowel volvulus and ileo-sigmoid knotting. Presence of bowel gangrene was associated with higher morbidity and mortality rates.

Treatment for ileosigmoid knotting: a single-center experience of 74 patients

Ileosigmoid knotting (ISK) is the wrapping of the ileum around the base of the sigmoid colon. The purpose of this study was to investigate the outcomes for patients undergoing various treatments for ISK. The clinical records of 74 ISK patients, over 46.5 years, were reviewed retrospectively. Emergency surgical procedures included resection with primary anastomosis or stoma for patients with gangrenous bowel segments, and detorsion or an additional definitive procedure for patients with viable bowel. Application of these procedures resulted in mortality rates of 0.0% in 14 patients with viable bowel, 12.5% in 8 patients with ileal gangrene, 14.3% in 7 patients with sigmoid colon gangrene, and 28.9% in 45 patients with double-segment gangrene. The principal strategy in the treatment for ISK is early and effective resuscitation followed by emergency surgery, including untying the knot, excising the gangrenous bowel segment, restoring intestinal continuity by primary anastomosis if possible, and preventing recurrence in selected patients.

Factors affecting bowel gangrene development in patients with sigmoid volvulus.

BACKGROUND AND OBJECTIVESSigmoid gangrene develops in 6.1% to 93.4% of sigmoid volvulus (SV) cases, and increases the mortality rate from 0% to 40% without bowel gangrene to 3.7% to 80%. This study aimed to investigate factors that induce bowel gangrene development in SV patients.DESIGN AND SETTINGSRetrospective study from a single center.PATIENTS AND METHODSWe determined whether there was any correlation between sigmoid gangrene and the following factors: age, gender, a previous history of a volvulus, previous history of abdominal surgery, pregnancy, major comorbidities, shock, duration of symptoms, direction and degree of rotation of volvulus, and ileosigmoid knotting.RESULTSOf 442 patients, 271 (61.3%) had sigmoid gangrene. The presence of pregnancy was negatively correlated with sigmoid gangrene development (P<.05), while comorbid diseases (P<.01), associated shock (P<.01), prolonged symptom duration (P<.05), overrotation (P<.05), and associated ileosigmoid knotting (P<.01) were positively correlated with bowel gangrene. However, no correlation was observed between sigmoid gangrene and the other studied factors.CONCLUSIONAn inverse correlation between pregnancy and sigmoid gangrene was observed. On the other hand, a positive correlation was noted between bowel gangrene and comorbid diseases, shock, prolonged duration of symptoms, overrotation, and associated ileosigmoid knotting.

The "small" wrapping around the "large"!

This is a case report of a 32-year-old female who presented with acute intestinal obstruction. The radiological diagnostic possibilty of midgut volvulus with ileo-sigmoid knotting and obstruction of the proximal sigmoid colon and small bowel was given. The diagnosis was confirmed intra-operatively with associated gangrene of the distal jejunum and proximal ileum. Resection of the gangrenous segments of bowel and the release of ileo-sigmoid knotting was performed. The literature about the ileo-sigmoid knot was reviewed. It may be difficult to diagnose this condition before surgery. This is a surgical emergency that requires urgent resection of gangrenous bowel and untwisting of the volvulus. The aim of this short communication is to increase awareness of the pre-operative computed tomography (CT) diagnosis of this condition.

Ileosigmoid knot – A Surgeon’s Nightmare

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 30-year-old male, who presented with lower abdominal pain. On examination, there was tenderness in the suprapubic area and later, the patient developed features of peritonitis. Exploratory laparotomy revealed a large volume of haemorrhagic fluid with gangrenous sigmoid colon, distended and gangrenous ileum twisted round the base of the sigmoid loop. Gangrenous portion of the ileum and sigmoid colon was resected and end to end anastomosis with Hartmann's procedure was done.

Ileosigmoid knotting: clinical appearance of 73 cases over 45.5 years

Ileosigmoid knotting (ISK) is the wrapping of the ileum around the base of the sigmoid colon. The aim of this study was to investigate the clinical outcomes of 73 patients with ISK over 45.5 years. The clinical records were reviewed retrospectively. The age range was 7-92 years (mean 46.7 years), and 54 patients (74.0%) were male. Forty-two patients (57.5%) experienced shock. The symptom duration range was 12-120 h (mean 46.5 h). The most common clinical features were abdominal pain and tenderness in 73 patients (100.0%), obstipation in 72 patients (98.6%), distention in 70 patients (95.9%) and vomiting in 61 patients (83.6%). The rate of correct diagnosis was 4.1% when based on clinical and X-ray findings (3/73) and 100.0% when based on computed tomography or magnetic resonance imaging findings (4/4 and 2/2, respectively). The diagnosis of ISK was confirmed by surgery in all cases. ISK is a rare disease that occurs most commonly in adult men. The disease is generally associated with shock, and the clinical features generally present as a mechanical bowel obstruction. Although X-rays may aid diagnosis, computed tomography and magnetic resonance imaging are more reliable diagnostic tools. However, the diagnosis is made at laparotomy in some cases.

The unusual volvulus : a five year retrospective analysis of nine cases.

The ileosigmoid knot is a rare surgical emergency. It is an unusual type of bowel obstruction in which the ileum usually wraps around the base of the sigmoid colon and forms a pseudoknot. It is usually associated with difficult preoperative diagnosis and poor surgical outcome. To analyze the clinical presentations, operative findings, management, postoperative complications and outcome of patients with ileosigmoid knotting. A retrospective analysis of nine cases of ileosigmoid knotting over a 6-year period from July 2005 to May 2011. Ileosigmoid knotting was common in males in the fifth decade. Mean duration of symptoms prior to admission was 42.67h. Both the ileum and the sigmoid colon were gangrenous in all the patients. Mortality was 22.22%. The mean duration of hospital stay was 13.67days. To conclude, ileosigmoid knotting, though a rare cause of intestinal obstruction, carries a significant risk of mortality. In our study, ileostomy along with colorectal anastomosis seemed to be a better and safer alternative than primary repair in the management of ileosigmoid knotting. Awareness of this condition among surgeons will help to reduce the morbidity and mortality associated with this unusual form of intestinal obstruction.

Ileosigmoid knotting in pregnancy

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.