title: Ileosigmoidal knotting in children: a review of 9 cases.
abstract: BACKGROUND
  The purpose of this study was to review nine pediatric cases of ileosigmoidal knotting (ISK), which is an unusual form of intestinal obstruction common in adults, characterized by double-loop obstruction.
  
  
  METHODS
  A retrospective analysis was designed to examine preoperative, operative, and postoperative findings of the nine children with ISK who were surgically treated in a university hospital throughout a 38.5-year period.
  
  
  RESULTS
  The mean age was 10.6 years (range: 7-16 years). Seven patients (77.8 %) were male. The most common symptoms were abdominal pain, distention, obstipation, and vomiting, and the most common signs were abdominal tenderness and distention. The most common form was type 1A in 4 patients (44.4%) in whom the active ileum encircled the passive sigmoid colon in clockwise direction. There was a gangrene in both ileum and sigmoid colon in 7 patients (77.8%), one patient (11.1%) had gangrene in only the sigmoid colon, and the bowels were viable in 1 patient (11.1%). In the gangrenous cases, nonviable small bowel segments were resected, and anastomosis was performed, while gangrenous sigmoid colon was resected and Hartmann procedure or primary anastomosis was used. In the nongangrenous case, detorsion was performed and sigmoidopexy was added. One patient in this series (11.1%) died.
  
  
  CONCLUSIONS
  Ileosigmoidal knotting is a rare disease in children. Its preoperative diagnosis is not easy. It is generally misdiagnosed as an obstructive emergency. Aggressive preoperative resuscitation, effective and prompt surgery, and postoperative support are the basic principles of treatment. Although resection with primary anastomosis is advised in gangrenous cases, stomas may be lifesaving in unstable patients. In nongangrenous cases, definitive surgical procedures are generally used.
authors.affiliation: Department of General Surgery, Atatürk University School of Medicine, Erzurum, Turkey. ssa@atauni.edu.tr
authors.forename: S Selçuk
authors.initials: SS
authors.lastname: Atamanalp
authors.forename: Durkaya
authors.initials: D
authors.lastname: Oren
authors.forename: M Ilhan
authors.initials: MI
authors.lastname: Yildirgan
authors.forename: Mahmut
authors.initials: M
authors.lastname: Başoğlu
authors.forename: Bülent
authors.initials: B
authors.lastname: Aydinli
authors.forename: Gürkan
authors.initials: G
authors.lastname: Oztürk
authors.forename: Bedii
authors.initials: B
authors.lastname: Salman
mesh_terms: D000293:Adolescent; D002648:Child; D003106:Colon / Q000473:pathology; D005260:Female; D005734:Gangrene; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis / Q000601:surgery*; D007082:Ileum / Q000473:pathology; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000175:diagnosis / Q000601:surgery*