A RARE CASE OF ILEOSIGMOID KNOTTING CAUSING INTESTINAL OBSTRUCTION CASE REPORT AND REVIEW OF LITERATURE

OBJECTIVE Ileosigmoid knotting, also called compound volvulus or double volvulus is a rare cause of intestinal obstruction. The condition is serious, generally progressing rapidly to gangrene. We report a case of ileosigmoid knotting in a 52-year-old male and its management. METHOD Case report and review of literature CASE REPORT A 52 year old man came with complaints of abdominal pain for past one day. Pain was sudden onset, colicky in nature, more in the lower abdomen. Patient had three episodes of vomiting which was not bile stained or blood stained. Patient has not passed flatus after the pain started. On general examination, patient was conscious, oriented, afebrile, not anemic, not icteric, no generalised lymphadenopathy. PR102min, BP11076mmHg. Abdomen examination showed distension with diffuse tenderness, guarding and rigidity. Bowel sounds were absent. X-ray Abdomen erect showed sigmoid volvulus with multiple air fluid levels. Ultrasound abdomen showed dilated bowel loops with free fluid. CECT abdomen showed dilated jejunal, ileal loops with transition point in distal jejunum noted in left hypochondrium with free fluid, suggestive of intestinal obstruction. Emergency laparotomy was done which showed an Ileosigmoid knotting with gangrene of sigmoid colon and terminal ileum. Resection of gangrenous sigmoid colon was done followed by primary anastomosis of descending colon with rectum and resection of gangrenous terminal ileum was done with a proximal ileostomy. Postoperative period was uneventful. CONCLUSION Ileosigmoid knotting is a rare cause of intestinal obstruction with only 280 cases reported in Literature. Awareness of the condition is essential for prompt diagnosis and optimal management.