European Journal of Biomedical and Pharmaceutical Sciences

A RARE CASE OF TYPE 2A ILEOSIGMOID KNOTTING- A CASE REPORT

Dr. Sinjini Pan*, Prof. (Dr) Subhabrata Das, Dr. Arnab Mandal, Dr. Debapratim De, Dr. Sagar Mridha and Dr. Shirshendu Sekhar Tikadar

ABSTRACT

Ileosigmoid knotting is the wrapping of the ileum or sigmoid colon around the other one and its mesentery. It is a rare cause of closed loop intestinal obstruction and rapidly progresses to gangrene resulting in high morbidity and mortality. Here we have reported a case of type 2 ISK in which the sigmoid colon (Active component) resolves around the ileum (Passive component). A 62 year old gentleman presented in the emergency with symptoms and signs of acute intestinal obstruction with peritonitis. Radiological findings were inconclusive. After adequate resuscitation, we planned for an exploratory laparotomy. After opening the abdomen with midline incision, we found that the sigmoid colon as an active component wrapped itself around the mesentry of gangrenous loops of ileum in clockwise direction and itself became gangrenous also. After derotation, we found 144 cm of distal ileum was gangrenous. Gangrenous part of sigmoid colon was resected with end to end colorectal anastomosis. Gangrenous segments of ileum was resected with preservation of proximal 138 cm small gut and exteriorised as double barrel ileostomy. Patient initially suffered from malnutrition but overall recovery was excellent. After six months, ileostomy reversal was done. The aims and objectives of the case report is to make clinicians aware about the condition, to explain the need of strong clinical suspicion and timely diagnosis. Because of atypical radiological finding and non specific symptoms and sign it is often difficult to reach a correct diagnosis. Intraoperative decision making and choice of surgical procedure is also important.

Keywords: Ileosigmoid knotting, Closed loop obstruction, Rare, Gangrene, High mortality.