Ileosigmoidal knotting: outcome in 63 patients.
OBJECTIVE
This study was designed to review the outcomes of 63 patients with ileosigmoidal knotting.


METHODS
Sixty-three, surgically treated patients (47 males; 74.6 percent) were reviewed retrospectively. The mean age was 45.6 (range, 7-75) years. The most common symptoms were abdominal pain and obstipation, and the most common signs were abdominal tenderness and distention. The preoperative diagnosis was obstructive emergencies in 49 patients (77.8 percent) and nonobstructive emergencies in 14 (22.2 percent).


RESULTS
All patients underwent emergency laparotomy. The most common type of ileosigmoidal knotting was Type 1A in 30 patients (47.6 percent), in which the active ileum encircled the passive sigmoid colon in a clockwise direction. Fifty patients (79.4 percent) developed gangrenous bowel. Resection of gangrenous segments and enteroenteric or enterocolic anastomosis combined with the Hartmann procedure was the most preferred operation, used in 34 patients (54 percent). The mortality rate was 15.9 percent (10 patients), and toxic shock was the most frequent cause of death.


CONCLUSIONS
Ileosigmoidal knotting is a rare but serious form of intestinal obstruction. Its preoperative diagnosis is difficult and may present as an obstructive or nonobstructive emergency. Early and effective resuscitation, prompt surgical intervention selected on the basis of clinical and operative findings, and effective postoperative intensive care are the basis of treatment.
Atamanalp
S Selçuk
SS
Department of General Surgery, Atatürk University, School of Medicine, Erzurum, Turkey. ssa@atauni.edu.tr
Oren
Durkaya
D
Başoğlu
Mahmut
M
Yildirgan
M Ilhan
MI
Balik
Ahmet A
AA
Polat
K Yalçin
KY
Celebi
Fehmi
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000150:complications / Q000601:surgery*; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome