Type IIB Ileosigmoid knotting: a case report

Abstract

Ileosigmoid knotting is a rare cause of acute intestinal obstruction. It is more common in Africans and Asians than in white populations and it is more prevalent in males than in females with a ratio of 14:1. It is classified into four types (I, II, III and IV) with further extra two subtypes of A and B where type A is the most common presentation.

Preoperative diagnosis is a challenge to the frontline doctors in the accidents and emergency departments; especially with limited diagnostic tools. Ultrasonography may be misleading in most of the cases due to the similarity of the disease with other causes of acute abdomen, especially acute appendicitis.

Clinical presentation of an unprecedented intestinal obstruction with constant upper to mid-abdominal quadrant pain associated with mild to moderate abdominal distension contrary to the severe abdominal distension in sigmoid volvulus are the hallmarks that can help the surgical team to reach an accurate and early diagnosis preoperatively to avoid the devastating ischemia and gangrene in case of delay.

Emergency laparotomy with possible resection and primary anastomosis in type I or resection and exteriorization with ileostomy or colostomy in the other types is recommended.

Keywords: ileosigmoid knotting, intestinal obstruction, South Sudan