Management of ileosigmoid knotting

Background Ileosigmoid knotting is a rare cause of intestinal obstruction. Methods The clinical records of 16 patients treated for ileosigmoid knotting were evaluated retrospectively. Results There were 11 men and five women. The mean age was 45 years. The mean duration of symptoms was 4.4 days. Plain abdominal radiographs showed multiple air-fluid levels in the colon and/or small bowel. At operation, ileum and/or sigmoid colon necrosis was observed in 13 patients, both ileum and total colon necrosis in two, while there was no necrosis in one patient. Resection of necrotic bowel was necessary in 15 patients, Intestinal continuity was restored by primary anastomosis in 12; three required a stoma. The patient without necrosis was treated by detorsion and mesosigmoplasty. Three of 16 (19 per cent) patients died; septic shock was the major cause of death. Conclusion Aggressive preoperative resuscitation, appropriate antibiotic therapy, effective surgery and postoperative metabolic support help minimize morbidity and mortality rates.