Intestinal obstruction due to ileo-sigmoid knotting in a child: a case report

Introduction

Ileo-sigmoid knotting is a rare cause of intestinal obstruction in which the ileum twists around the base of the sigmoid colon, or vice versa, forming a knot that creates a double closed-loop obstruction and can lead to bowel ischemia and necrosis.

Case presentation

A 7-year-old boy presented with a 12-hour history of worsening abdominal pain, initially colicky and central, later becoming diffuse, accompanied by bilious vomiting. On examination, the child appeared acutely ill and lethargic, with signs of hypovolemic shock including tachycardia (145 bpm), hypotension (80/45 mmHg), feeble pulses, and dry mucous membranes. The abdominal examination revealed marked distention and generalized tenderness. X-ray of the abdomen showed multiple centrally located air fluid levels. Laboratory results showed leukocytosis with neutrophilia. After fluid resuscitation and stabilization, he was taken to the operating room for an emergency laparotomy. We found a 100cm-long segment of ischemic ileum caused by a counterclockwise knot formed by a redundant sigmoid colon. The knot was untwisted, and the gangrenous ileum was resected. Because there was only a very short segment of healthy ileum proximal to the ileocecal valve, we did a limited right hemicolectomy and an ileo-colic anastomosis. The child recovered well and was discharged on the fifth postoperative day. He remained asymptomatic on the last follow up visit, one month after the operation.

Conclusion

Ileo-sigmoid knotting should be included in the differential diagnosis of children who develop acute abdominal pain with signs of intestinal obstruction.