Ba-Shammakh Saleh A, Rabai Nimah A, Haj-Freej Hasn M, Ghanem Waleed H, Wahsheh Mohamad N
Department of General Surgery, Princess Basma Teaching Hospital, Irbid, JOR.
Department of General Surgery, The Islamic Hospital, Amman, JOR.
Cureus. 2023 Jul 31;15(7):e42749. doi: 10.7759/cureus.42749. eCollection 2023 Jul.
The present study focuses on ileosigmoid knotting (ISK), an infrequent but potentially lethal surgical emergency. ISK is more frequently observed in males and is prevalent in regions with high rates of sigmoid volvulus. The current medical scenario revolves around the intricate intertwining of the ileum and sigmoid colon, leading to a complicated volvulus. This condition often results in acute intestinal obstruction, which can subsequently cause bowel necrosis. The clinical presentation of the condition is characterized by symptoms such as abdominal distention, pain, vomiting, and obstipation, which can be misleading as they are similar to other common abdominal conditions. A delay in definitive diagnosis and intervention is likely, which can lead to severe consequences such as peritonitis, bowel necrosis, sepsis, and even septic shock. Our case report discusses an instance of ISK presenting as an acute abdomen requiring an emergency laparotomy and detorsion of the volvulus-knotted segment, followed by an elective sigmoidectomy. The significance of a heightened level of suspicion, prompt decision-making, and timely surgical intervention in achieving better patient outcomes cannot be overstated. The objective is to enhance the medical community's understanding of ISK, focusing on early diagnosis and effective treatment of this rare but life-threatening disease.
本研究聚焦于回肠乙状结肠扭结(ISK),这是一种罕见但可能致命的外科急症。ISK在男性中更常见,且在乙状结肠扭转发生率高的地区较为普遍。当前的病情状况围绕着回肠和乙状结肠的复杂缠绕,导致形成复杂的扭转。这种情况常导致急性肠梗阻,进而可引起肠坏死。该病症的临床表现以腹胀、疼痛、呕吐和便秘等症状为特征,由于这些症状与其他常见腹部疾病相似,可能会产生误导。很可能会出现确诊和干预延迟的情况,这可能导致诸如腹膜炎、肠坏死、败血症甚至感染性休克等严重后果。我们的病例报告讨论了一例表现为急腹症的ISK病例,该病例需要进行急诊剖腹手术并对扭转扭结段进行扭转复位,随后进行择期乙状结肠切除术。高度怀疑、迅速决策和及时手术干预对于实现更好的患者预后的重要性再怎么强调也不为过。目的是增强医学界对ISK的认识,重点关注对这种罕见但危及生命的疾病的早期诊断和有效治疗。