Rahimi-Movaghar Ehsanollah, Tahouri Tahmineh
Department of Surgery, Farhikhtegan Hospital, Faculty of Medicine, Tehran Medical Science, Islamic Azad University, Tehran, Iran.
Shahid Modarres Educational Hospital, Shahid Beheshti University of Medical Science, Faculty of Medicine, Tehran, Iran.
Int J Surg Case Rep. 2022 Sep;98:107511. doi: 10.1016/j.ijscr.2022.107511. Epub 2022 Aug 13.
Ileosigmoid knotting is an unusual cause of intestinal obstruction in which the ileum wraps around the base of the sigmoid colon and its mesentery, which leads to a closed loop intestinal obstruction.
A 59-year-old male patient was referred to our center with acute abdominal pain, obstipation and a few episodes of vomiting. On physical examination, he had hypotension and tachycardia as well as distension, diffused tenderness, guarding and rebound tenderness of the abdomen. Bowel sounds were absent. Abdominal Plain X-ray showed dilatation of the large bowel associated with the distended small bowel. After resuscitation with aggressive intravenous fluid therapy, the patient underwent an emergency laparotomy. Exploration revealed gangrene of the intestinal loops, including the jejunum and ileum, which was secondary to a 360° clockwise twisting of the ileal loops around the sigmoid colon. Gangrene of the sigmoid colon along with torsion of the superior mesenteric arteries was also obvious. Resection of the gangrenous loops of the small bowel as well as a sigmoidopexy was carried out and a primary anastomosis of the small intestine and colon was performed. He did well post-operatively.
It is crucial to distinguish Ileosigmoid knotting from sigmoid volvulus because it can rapidly, even within hours, progress to bowel gangrene and peritonitis; moreover, in this situation the endoscopic reduction is contraindicated.
Ileosegmoid knotting is an unusual cause of bowel obstruction which has relatively high mortality rates and should be considered in patients with acute abdominal pain and presentations of bowel obstruction.
回肠乙状结肠扭结是肠梗阻的一种罕见病因，即回肠围绕乙状结肠及其系膜根部扭转，导致闭袢性肠梗阻。
一名59岁男性患者因急性腹痛、便秘及数次呕吐被转诊至我院。体格检查发现患者有低血压、心动过速，腹部膨隆、弥漫性压痛、肌紧张及反跳痛。肠鸣音消失。腹部平片显示大肠扩张并伴有小肠扩张。经积极静脉补液复苏后，患者接受了急诊剖腹探查术。探查发现肠袢坏疽，包括空肠和回肠，这是由于回肠袢沿顺时针方向围绕乙状结肠扭转360°所致。乙状结肠坏疽及肠系膜上动脉扭转也很明显。切除坏死的小肠袢并行乙状结肠固定术，同时对小肠和结肠进行一期吻合。患者术后恢复良好。
将回肠乙状结肠扭结与乙状结肠扭转区分开来至关重要，因为它可在数小时内迅速发展为肠坏疽和腹膜炎；此外，这种情况下禁忌内镜复位。
回肠乙状结肠扭结是肠梗阻的一种罕见病因，死亡率相对较高，对于急性腹痛和肠梗阻表现的患者应予以考虑。
