An ileosigmoid knot or compound volvulus is an uncommon cause of intestinal blockage.[1] The condition arises when ileum loops wrap around the bottom of a redundant sigmoid loop.[2] In some countries in Africa, Asia, and the Middle East, the ileosigmoid knot is a well-known ailment; this condition is uncommon in the West.[3]
| Ileosigmoid knot | |
|---|---|
| Specialty | Gastroenterology |
Signs and symptoms
editIleosigmoid knotting typically manifests as sudden, severe abdominal pain. It can quickly worsen into sigmoid colon and ileum gangrene, which can lead to potentially fatal side effects like sepsis, generalized peritonitis, electrolyte imbalance, and dehydration.[4] Abdominal pain and tenderness (100%) and distension of the abdomen (94%–100%), vomiting and nausea (87–100%), rebound tenderness (69%), as well as shock (0–60%) are the main symptoms and presentation indicators.[3][5]
Causes
editThe ileosigmoid knot is caused by three things: eating a high-bulk diet while the small bowel is empty; having a long, sigmoid colon on a tiny pedicle; and having a long, mesentery, and freely moving small bowel. The intestines become more mobile when a semi-liquid, heavy meal moves into the proximal jejunum, and the heavier sections of the jejunum fall to the left lower quadrant. Around the base of the narrow sigmoid colon, the empty loops of the ileum and distal jejunum rotate in a clockwise direction. With two closed-loop obstructions—one in the small bowel and the other in the sigmoid colon—further peristalsis creates an ileosigmoid knot.[6]
Diagnosis
editEven though radiographic findings indicate colonic obstruction, which is uncommon in small bowel obstruction, clinical features like vomiting point to small bowel obstruction.[7] Ileosigmoid knotting is frequently confused radiographically with a straightforward sigmoid volvulus. On the other hand, in contrast to sigmoid volvulus, attempts to deflate the enlarged colon with a flatus tube or sigmoidoscope frequently fail and may even be hazardous in ileosigmoid knotting. This is because the ileum firmly encloses the sigmoid colon's base, thwarting any such attempt.[4] These three characteristics—the inability to insert a sigmoidoscope, radiographic evidence of primarily large bowel obstruction, and the clinical picture of small bowel obstruction—might make up a helpful diagnostic triad.[8]
Due to their unfamiliarity, the radiographic findings of ileosigmoid knotting—which include multiple air-fluid levels in the small intestine and a double loop of dilated sigmoid shadow—are only occasionally described.[9][10]
The descending colon, medial deviation of the cecum, and "the whirl sign," which is produced by the twisted intestinal tract and sigmoid mesocolon in ileosigmoid knot, are findings in a CT scan that are suggestive of ileosigmoid knotting. Furthermore, some have observed the radial distribution of the mesenteric vasculature and the intestine and believe this to be useful diagnostic data.[4]
Classification
editIleosigmoid knotting has been classified into the three types listed below:[4]
Type 1: The ileum, which is the active component, encircles the sigmoid colon, which is the passive component, either clockwise or counterclockwise (type A when clockwise and type B when counterclockwise).[4]
Type 2: In either a clockwise or counterclockwise direction, the sigmoid colon, the active component, encircles an ileum loop, the passive component.[4]
Type 3: The sigmoid colon (passive component) is encircled by the ileocecal segment (active component).[4]
Treatment
editAggressive resuscitation with fluid and electrolytes, along with the correction of any acid-base imbalance, are the initial management measures. The earliest possible surgical intervention should be performed following hemodynamic stabilization. After the procedure, appropriate antibiotic therapy is started as soon as possible and is continued for 5-7 days. Metronidazole, aminoglycosides, and cephalosporins are the typical antibiotic combinations.[4]
Epidemiology
editMales account for 80.2% of cases of ileosigmoid knotting, with a mean age of 40 years (range: 4-90 years). The literature indicates the presence of additional secondary causative factors in addition to the aforementioned anatomic prerequisites, such as late pregnancy, Meckel's diverticulitis with a band, trans mesenteric herniation, floating cecum, and ileocecal intussusceptions.[6]
Ileosigmoid knotting is uncommon in the white population, although it is primarily documented in some African, Asian, and Middle Eastern countries.[11]
History
editE Parker is credited with describing the first case of ileosigmoid knotting in 1846.[12]
See also
editReferences
edit- ^ Miller, Brian J.; Borrowdale, Roderick C. (1992). "Ileosigmoid Knotting: A Case Report and Review". Australian and New Zealand Journal of Surgery. 62 (5). Wiley: 402–404. doi:10.1111/j.1445-2197.1992.tb07213.x. ISSN 0004-8682. PMID 1575664.
- ^ Lee, Sang-Hoon; Park, Young Ha; Won, Yong Sung (2000). "The Ileosigmoid Knot: CT Findings". American Journal of Roentgenology. 174 (3): 685–687. doi:10.2214/ajr.174.3.1740685. ISSN 0361-803X. PMID 10701609.
- ^ a b Alver, Olcay; Ören, Durkaya; Tireli, Mustafa; Kayabaşi, Bayram; Akdemir, Dursun (1993). "Ileosigmoid knotting in Turkey". Diseases of the Colon & Rectum. 36 (12). Ovid Technologies (Wolters Kluwer Health): 1139–1147. doi:10.1007/bf02052263. ISSN 0012-3706. PMID 8253011. S2CID 24903810.
- ^ a b c d e f g h Mandal, Ajay; Chandel, Vivek; Baig, Sarfaraz (April 2012). "Ileosigmoid Knot". The Indian Journal of Surgery. 74 (2): 136–142. doi:10.1007/s12262-011-0346-y. ISSN 0972-2068. PMC 3309095. PMID 23542502.
- ^ Shepherd, J. J. (June 1967). "Ninety-two cases of ileosigmoid knotting in Uganda". The British Journal of Surgery. 54 (6): 561–566. doi:10.1002/bjs.1800540615. ISSN 0007-1323. PMID 6026331. S2CID 46527196.
- ^ a b Machado, Norman O. (2009). "Ileosigmoid knot: a case report and literature review of 280 cases". Annals of Saudi Medicine. 29 (5): 402–406. doi:10.4103/0256-4947.55173. ISSN 0256-4947. PMC 3290047. PMID 19700901.
- ^ Puthu, D.; Rajan, N.; Shenoy, G. M.; Pai, S. U. (February 1991). "The ileosigmoid knot". Diseases of the Colon and Rectum. 34 (2): 161–166. doi:10.1007/BF02049992. ISSN 0012-3706. PMID 1993413. S2CID 30440284.
- ^ Raveenthiran, V. (August 2001). "The ileosigmoid knot: new observations and changing trends". Diseases of the Colon and Rectum. 44 (8): 1196–1200. doi:10.1007/BF02234644. ISSN 0012-3706. PMID 11535862. S2CID 39868446.
- ^ Atamanalp, S. Selçuk; Oren, Durkaya; Başoğlu, Mahmut; Yildirgan, M. Ilhan; Balik, Ahmet A.; Polat, K. Yalçin; Celebi, Fehmi (June 2004). "Ileosigmoidal knotting: outcome in 63 patients". Diseases of the Colon and Rectum. 47 (6): 906–910. doi:10.1007/s10350-004-0528-9. ISSN 0012-3706. PMID 15129310. S2CID 20579630.
- ^ Hirano, Y.; Hara, T.; Horichi, Y.; Nozawa, H.; Nakada, K.; Oyama, K.; Hada, M.; Takagi, T.; Hirano, M.; Kitagawa, K. (2005). "Ileosigmoid knot: case report and CT findings". Abdominal Imaging. 30 (6): 674–676. doi:10.1007/s00261-005-0315-7. ISSN 0942-8925. PMID 15834675. S2CID 8469787.
- ^ Fouquet, Virginie; Berrebi, Dominique; De Lagausie, Pascal; Azeinfish, Sophie; Chalard, François; Peuchmaur, Michel; Aigrain, Yves (December 2006). "Ileosigmoid knotting in a child. The first case report in a French girl". Gastroenterologie Clinique et Biologique. 30 (12): 1414–1416. doi:10.1016/s0399-8320(06)73574-6. ISSN 0399-8320. PMID 17211345.
- ^ Parker, E (1846). "Case of Intestinal Obstruction; Sigmoid Flexure strangulated by the Ileum". The American Journal of the Medical Sciences. 11 (22): 464–465. doi:10.1097/00000441-184604000-00053.
Further reading
edit- Atamanalp, S. Selçuk; Oren, Durkaya; Yildirgan, M. Ilhan; Başoğlu, Mahmut; Aydinli, Bülent; Oztürk, Gürkan; Salman, Bedii (January 2007). "Ileosigmoidal knotting in children: a review of 9 cases". World Journal of Surgery. 31 (1): 31–35. doi:10.1007/s00268-006-0255-6. ISSN 0364-2313. PMID 17171493. S2CID 23944985.
- Kakar, A.; Bhatnagar, B. N. (October 1981). "Ileo-sigmoid knotting: a clinical study of 11 cases". The Australian and New Zealand Journal of Surgery. 51 (5): 456–458. doi:10.1111/j.1445-2197.1981.tb05984.x. ISSN 0004-8682. PMID 6947787.