Ileosigmoid knotting: A rare cause of acute abdomen with fatal outcome in a 60-year-old man: Case report from a resource-limited setting.

Introduction and importance: Ileosigmoid knotting(ISK), a rare but life-threatening condition which first described in 1845. It occurred when the ileum twisting around the sigmoid colon and causing intestinal obstruction and potential perforation.

Presentation of case: A 60-year-old male from the Garbo region of Somali, Ethiopia, presented to the hospital after a a four-day history of intestinal obstruction symptoms. On examination, he was tachycardic and febrile, and exhibited diffuse abdominal tenderness. A diagnosis of intestinal obstruction with generalized peritonitis was made after abdominal x ray. The patient was resuscitated with fluids, started on antibiotics, and a nasogastric tube was placed. Emergency laparotomy revealed ileosigmoid knotting with gangrenous bowel. En bloc resection of the affected ileum and sigmoid colon was performed. An ileo-jejunal anastomosis and an end colostomy were constructed. Despite these interventions, the patient succumbed to uncontrolled sepsis on the fourth postoperative day.

Clinical discussion: Ileosigmoid knotting (ISK), a rare and deadly form of intestinal obstruction, is more common in the "volvulus belt" regions like Africa and parts of Asia. It involves a twisted knot of the ileum and sigmoid colon and can be caused by factors like a narrow mesentery or hypermobile ileum. ISK is difficult to diagnose with standard tests and often requires surgical exploration. The mortality is high (up to 48 %), especially in resource-limited settings due to various challenges.

Conclusion: Ileosigmoid knotting is a rare and dangerous cause of intestinal obstruction requiring quick action. Poor outcomes are common, especially in resource-limited areas like Ethiopia due to late presentation and limited healthcare resources.