Ekehorn () and Faltin () in their studies classified the ileosigmoid knot according to bowel involved and arrangement of loops. The ileosigmoid knot (also known as compound volvulus) is a rare cause of intestinal obstruction [1]. The condition is initiated by loops of ileum wrapping around. he ileosigmoid knot (also known as compound volvulus) is a rare cause of intestinal obstruction [1]. The condition is initiated by loops of ileum wrapping.

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A peritoneal tap revealed the fluid to be hemorrhagic. Predisposing factors and pre-operative investigation done for diagnosis as by various authors. Ileosigmoid knotting in a child: Dis Colon Rectum ; Current Research View More. Nil, Conflict of Interest: Inability to negotiate sigmoidoscope or a flatus tube.

Ileosigmoid knot: a case report and literature review of 280 cases

The first case from India knkt reported by Dunkertey A year-old male patient with a history of chronic constipation was admitted with severe lower abdominal pain of hour duration.

Create a free personal account to download free article PDFs, sign up for alerts, and more. After hemodynamic stabilization, operative intervention should be undertaken as early as possible.

This article has been cited by other articles in PMC. Resection of the sigmoid colon is often advised knpt all instances even when it is viable. Diseases of the Colon and Rectum.

Ileosigmoid Knot

In the past, a Hartmann operation or a covering colostomy was advocated to avoid the risk of fecal leak from colonic anastomosis. In type II, the sigmoid colon active component wraps itself around a loop of ileum passive component in a clockwise or anticlockwise direction. The empty loops of ileum and distal jejunum twist in a clockwise rotation around the base of a narrow sigmoid colon. In this condition the ileum wraps around the base of the sigmoid colon and forms a knot.


A year-old male was brought to the emergency department with severe pain and distension of abdomen for 12 hours duration, which he developed in the later part of the night. The long arrow points to the knot while the short arrows point to the medial displacement of the descending colon and cecum. In recent years, CT has been helpful in making a preoperative diagnosis.

Parker has been credited for describing the first patient of ileosigmoid knot in Please review our privacy policy. These three features of onot clinical picture of small bowel obstruction, radiographic evidence of predominately large bowel obstruction, and inability to insert a sigmoidoscope could possibly form a useful diagnostic triad. Am J Roentgenol ; B Caudal CT scan section shows the whirl sign within the circle created by the twisted mesentery and bowel branches arising from the superior mesenteric artery are ileosigmoie in the whirl.

This is a surgical emergency that requires urgent resection of gangrenous bowel and untwisting of the volvulus. Besides the above anatomic prerequisites, the literature reveals the evidence of other secondary causative factors including late pregnancy, transmesenteric herniation, Meckel diverticulitis with a band, ileocecal intussusception, and floating ilfosigmoid.

In ileosigmokd of early judgment for prompt surgical intervention, the higher rates of both gangrene and mortality seem paradoxical and presumably reflect the fulminating clinical deterioration of patients due to early and extensive infarction of the bowel involved in a kbot knot. August 05, ; Accepted Date: Turk J Med Sci knoot Classification ISK has been categorized into the following three types: Vomiting, abdominal distension, abdominal pain, blood ilrosigmoid stools are frequent symptoms.

Clinical appearance of 73 cases over By using this site, you agree to the Terms of Use and Privacy Policy. The presence of the whirl sign on CT scan — medially deviated distal descending colon and cecum, with mesenteric vascular structures from the superior mesenteric vessels converging toward the sigmoid colon — can help clinch the diagnosis.


Ileosigmoid knot; Gangrenous total colon and distal ileum; Hartmann’s procedure with end ileostomy.

Showing of 7 references. The patient was immediately operated. Stretched and elongated superior mesenteric along with inferior mesenteric vascular structures converging toward the sigmoid colon also indicate the diagnosis.

While clinical features ileosigmmoid as vomiting suggest small bowel obstruction, the radiographic findings are that of colonic distension, which is uncommon in small bowel obstruction.

This article has been cited by other articles in PMC. There is medial deviation of the cecum with a pointed medial border thick arrow. We present one such patient we encountered and outline our management, and discuss the surgical options available. A new classification for ileosigmoid knotting.

Axial CT scan of the abdomen A shows ileosugmoid dilated loop of the sigmoid colon with a thinned-out wall thin arrow.

Ileosigmoid knot – Wikipedia

Total colectomy with distal ilectomy 50cms followed by Hartmann’s procedure with end ileostomy in the right iliac fossa was done. Ileosigmoidal Knotting in Children: It more commonly affects men who are in fourth decade of life.

It is difficult to diagnose this condition before surgery. The whirl sign is present on this section as well thin arrow.

The usual antibiotic combination includes cephalosporins, aminoglycosides, and metranidazole. In patients without sigmoid gangrene, mesosigmoidostomy is practiced by some to prevent recurrent ISK [ 371114 ]. October 02, Citation: