Ileosigmoid Knotting;A Case Report

Ileosigmoid knotting (ISK), also known as compound volvulus or double volvulus, is a rare cause of intestinal obstruction. The incidence of ISK is not well known, but it generally occurs in areas with a high incidence of sigmoid volvulus (SV). Ileosigmoid knotting is predominately seen in males (80.2%) with a mean age of 40 years. In an ileosigmoid knot, closed proximal loops of the ileum become congested and gangrenous within a few hours; therefore, early recognition and surgical treatment of ileosigmoid knots are essential. Despite the critical condition, in less than 20% of patients the diagnosis can be made preoperatively. The mean mortality rate is 6.8-8% in nongangrenous and 20100%-in gangrenous cases. The mortality figures are generally related to the duration of symptoms, the presence or absence of gangrene, and the general status of the patient, including the presence of septicemic shock. A 38-year-old man with a history of IV drug abuse presented with generalized abdominal pain which was severe in the epigaster and hypogaster regions. He had a history of obstipation since four days prior. Upon physical examination, the patient had abdominal tenderness and generalized guarding. Rectal examination was bloody. After adequate hydration, laparatomy was done and ileosigmoid knotting with gangrene of the terminal ileum were seen. A colostomy was performed in proximal end to end anastomosis, in the distal Hartman Poutch. The patient has been followed since three months ago, with no additional complaints at this time.