Viable Ileosigmoid Knotting, A Very Phenomenon Finding and Rare Cause of Intestinal Obstruction: A Case Report and Literature Review.

IF 0.7 Q3 MEDICINE, GENERAL & INTERNAL
International Medical Case Reports Journal Pub Date : 2025-02-05 eCollection Date: 2025-01-01 DOI:10.2147/IMCRJ.S502430
Sintayehu Asrat Beyene, Nahom Tadesse Bogale, Mahad Mohammed Abdinasir, Addisu Zegeye Desalegne, Megdelawit Ayalew Wossen
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引用次数: 0

Abstract

Introduction: Ileosigmoid knotting is the wrapping of an active component of either the ileum or the sigmoid colon over each other. It is an unusual cause of intestinal obstruction, accounting for 1-2% of cases of all mechanical obstruction in the majority published literatures. A viable knot is a unique phenomenon of this seldom cause of bowel obstruction.

Case presentation: A sixteen-year-old female patient presents with a complaint of central abdominal distension and obstipation of 12-hour duration. Later, she also developed abdominal cramps and vomiting of ingested matter. Her vital signs were all in the normal range, and the abdominal examination was positive for a grossly distended abdomen with mild upper and central abdominal tenderness. The ileosigmoid knotting was clearly visible on the computed tomography. Emergency exploratory laparotomy was performed, and a viable ileosigmoid knot was identified. Unknotting, derotation, and decompression of the sigmoid colon were performed. The postoperative course was uneventful.

Discussion: Ileosigmoid knotting is a rare, life-threatening cause of intestinal obstruction with rapid progression to intestinal vascular compromise and gangrene. It is a hyperactive segment of ileum that winds around the pedicle of the redundant sigmoid colon, resulting in a closed-loop obstruction. There are different classification schemes of ileosigmoid knotting depending on the active component of the knot and based on the viability of the bowel and physiology of the patient. Preoperative diagnosis of this condition is often challenging and usually confirmed intraoperative.

Conclusion: A high index of suspicion and prompt surgical exploration are crucial for the best outcome of the patient. Despite being a rare cause of intestinal obstruction, ileosigmoid knotting poses a significant morbidity and mortality to the patient. Management of a patient with viable ileosigmoid knotting is controversial, as some scholars suggest non-resective options and others recommend resective treatment as a recurrence preventive measure.

可行的回肠乙状结肠结,一个非常罕见的现象和肠梗阻的原因:1例报告和文献复习。
导言:回肠乙状结肠结是将回肠或乙状结肠的活性成分相互包裹。这是一种罕见的肠梗阻原因,在大多数已发表的文献中占所有机械梗阻病例的1-2%。一个可行的结是一个独特的现象,这很少引起肠梗阻。病例介绍:一名16岁的女性患者,主诉腹胀,腹痛持续12小时。后来,她还出现腹部痉挛和呕吐。生命体征均在正常范围内,腹部检查呈明显腹胀,腹部上、中部有轻微压痛。计算机断层扫描显示回乙状结肠结清晰可见。急诊探查剖腹手术,并确定可行的回肠乙状结肠结。进行乙状结肠解结、旋转和减压。术后过程平淡无奇。讨论:回肠乙状结肠结是一种罕见的、危及生命的肠梗阻原因,可迅速发展为肠血管受损和坏疽。它是一段活跃的回肠,缠绕在多余乙状结肠的蒂上,导致闭环阻塞。回肠乙状结肠结有不同的分类方案,这取决于结的活性成分,并基于肠的生存能力和患者的生理。这种情况的术前诊断通常具有挑战性,通常在术中得到证实。结论:高度的怀疑和及时的手术探查对患者的最佳预后至关重要。尽管是一种罕见的肠梗阻的原因,但回肠乙状结肠结对患者造成了显著的发病率和死亡率。回肠乙状体结扎患者的处理是有争议的,一些学者建议非切除治疗,而另一些学者则建议切除治疗作为预防复发的措施。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
International Medical Case Reports Journal
International Medical Case Reports Journal MEDICINE, GENERAL & INTERNAL-
CiteScore
1.40
自引率
0.00%
发文量
135
审稿时长
16 weeks
期刊介绍: International Medical Case Reports Journal is an international, peer-reviewed, open access, online journal publishing original case reports from all medical specialties. Submissions should not normally exceed 3,000 words or 4 published pages including figures, diagrams and references. As of 1st April 2019, the International Medical Case Reports Journal will no longer consider meta-analyses for publication.
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