Kumar Raj, Kumar Shamanur Kenchappa Pavan, Meena Kusum, Singh Brijesh Kumar
Surgery, Lady Hardinge Medical College, New Delhi, Delhi, India.
BMJ Case Rep. 2019 May 30;12(5):e226663. doi: 10.1136/bcr-2018-226663.
Ileosigmoid knotting (ISK) is a rare cause of intestinal obstruction rapidly progressing to bowel gangrene. It is characterised by the wrapping of loops of ileum and sigmoid colon around each other. The condition often remains undiagnosed preoperatively; however, it can be suspected by the triad of small bowel obstruction, radiographic features suggestive of predominately large bowel obstruction and inability to deflate the intestine by a sigmoidoscope. We are reporting a case of 56-year-old man who presented with features of acute intestinal obstruction and compensated shock within 24 hours of onset of symptoms. Exploratory laparotomy revealed ISK resulting in gangrene of ileum and sigmoid colon. In view of haemodynamic instability, end ileostomy was done after excising gangrenous segments. The patient improved and stoma closure and ileocolic anastomosis were done after 3 months in follow-up.
回肠乙状结肠扭结（ISK）是导致肠梗阻并迅速发展为肠坏疽的罕见病因。其特征是回肠和乙状结肠肠袢相互缠绕。该病症在术前常难以诊断；然而，可通过小肠梗阻三联征、提示主要为大肠梗阻的影像学特征以及乙状结肠镜无法使肠道排气来怀疑此病。我们报告一例56岁男性患者，其在症状发作后24小时内出现急性肠梗阻和代偿性休克的症状。剖腹探查发现为回肠乙状结肠扭结，导致回肠和乙状结肠坏疽。鉴于血流动力学不稳定，在切除坏疽段后进行了末端回肠造口术。患者病情好转，随访3个月后进行了造口关闭和回结肠吻合术。
