Abebe Kirubel, Sherefa Kalid, Teshome Henok, Abebe Engida
Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Surg Res Pract. 2020 Jul 23;2020:3826138. doi: 10.1155/2020/3826138. eCollection 2020.
Ileosigmoid knotting (ISK) is an uncommon form of bowel obstruction due to wrapping of the ileum or sigmoid colon around the base of the other. It is associated with poor prognosis. Data on ISK are scarce in our country. The aim of this study was to assess clinical profiles, management, and outcome of patients operated for ISK. . A retrospective analysis of all patients operated for ISK at St. Paul's hospital millennium medical college (SPHMMC) from February 2014 to January 2020 was performed.
A total of 28 patients (M: = 3 : 1) were studied. The mean age was 41.7 years (SD ± 19.5) and ranged from 18 to 80 years. The mean duration of illness was 1.6 days (SD ± 1.1). Abdominal pain and vomiting were seen in all patients followed by abdominal distention (24, 85.7%) and failure to pass feces or flatus (23, 82.1%). Preoperative diagnosis was correct in 6 (21.4%) patients. Almost all patients (26, 92.8%) had gangrenous bowel. The commonest procedure performed was resection of the gangrenous segments with primary ileoileal anastomosis and sigmoid end colostomy (16, 57.1%). Complications were seen in 11 (39.3%) patients and the commonest being surgical site infection (SSI) (7, 25%). Death occurred in 6 (21.4%) patients, and it was significantly (=0.020) associated with intraoperative shock (systolic blood pressure (SBP) < 90 mmHg).
ISK lacks specific clinical features and imposes a significant rate of bowel strangulation, which deserves high index of suspicion and urgent laparotomy. The choice of surgical procedure should be determined by intraoperative bowel status and patients' general condition.
回肠乙状结肠扭结（ISK）是一种罕见的肠梗阻形式，由于回肠或乙状结肠围绕对方根部缠绕所致。它与预后不良相关。我国关于ISK的数据很少。本研究的目的是评估接受ISK手术患者的临床特征、治疗及预后。对2014年2月至2020年1月在圣保罗医院千禧医学院（SPHMMC）接受ISK手术的所有患者进行了回顾性分析。
共研究了28例患者（男∶女 = 3∶1）。平均年龄为41.7岁（标准差±19.5），年龄范围为18至80岁。平均病程为1.6天（标准差±1.1）。所有患者均出现腹痛和呕吐，其次是腹胀（24例，85.7%）和停止排气排便（23例，82.1%）。6例（21.4%）患者术前诊断正确。几乎所有患者（26例，92.8%）都有肠坏疽。最常进行的手术是切除坏疽段并进行回肠端端吻合和乙状结肠末端造口术（16例，57.1%）。11例（39.3%）患者出现并发症，最常见的是手术部位感染（SSI）（7例，25%）。6例（21.4%）患者死亡，且与术中休克（收缩压（SBP）<90 mmHg）显著相关（P = 0.020）。
ISK缺乏特异性临床特征，且肠绞窄发生率高，值得高度怀疑并紧急剖腹探查。手术方式的选择应根据术中肠管情况和患者一般状况来决定。
