Ileo-Sigmoid Knot: A Case Report

Introduction and Importance: The ileo-sigmoid knot is a rare entity of intestinal occlusion by strangulation. It is a surgical emergency whose delay in management exposes to digestive necrosis and high mortality.

Materials and Methods: Our work is a retrospective case report with a descriptive aim concerning a patient operated for retrocecal hernia within the department of general surgery of CHU Ibn Rochd Casablanca

Case presentation: We report the case of a 53-year-old male, who has an occlusive syndrome with abdominal pain. On physical examination, we noted a slightly distended abdomen with generalized abdominal tenderness. Abdominal CT scan detected a moderate amount of intraperitoneal fluid effusion. The first jejunal loops were flat and well raised by contrast injection, while the downstream small intestine was distended and poorly raised. The straight, transverse and descending segments of the colon, as well as the rectum, were normally positioned and aerated, but the sigmoid colon was not clearly visualized. The patient was operated, surgical exploration had found a liquid of intestinal suffering of medium abundance which was evacuated and removed; with a volvulus of the last hail and the cecum around the sigmoid in the form of a knot. Since the hail and the sigmoid colon were viable the patient benefited from a simple detorsion with sigmoidopexy.

Clinical discussion: The ileo-sigmoid volvulus, or ileo-sigmoid knot (NIS) is a "knot" created by a volvulus of the sigmoid colon and small intestine, specifically the ileum. It was first described by Parker in 1845 to explain the development of the ISK. Treatment is based on the resection of necrotic intestinal segments with anastomosis or stoma, detorsion and sigmoidopexy are recommended in the rare cases where there is no necrosis.

Conclusion: The ileo-sigmoid knot is a rare but potentially fatal cause of acute intestinal obstruction. Lack of knowledge of the condition and diagnostic difficulties have contributed to high morbidity and mortality. Only early diagnosis and prompt management can optimize the survival of these patients.