title: An unusual synchronous ileosigmoid and ileoileal knotting: a case report.
abstract: BACKGROUND
  Ileosigmoid and ileoileal knotting are two rare entities. They usually present as acute abdomen and the diagnosis is established intraoperatively. The treatment is surgical and should be performed as soon as possible to decrease the incidence of perioperative mortality and morbidity.
  
  
  METHODS
  We report an unusual case of a 26-year-old Argentine man with ischemic necrosis in parts of his small and large intestine due to combined ileosigmoid and ileoileal knotting. He had an ileal loop of ileum concurrently wrapped around the neck of a sigmoid volvulus and other loops of ileum strangulating them, forming two different tangles of tying. This very rare and unusual entity was diagnosed and managed intraoperatively during a diagnostic laparotomy performed on an emergency basis. Both the gangrenous small bowel loops and the affected sigmoid colon area were resected. The continuation of the intestinal tract was restored by primary end-to-end anastomoses. The present case is unusual and to the best of our knowledge no similar cases of simultaneous ileosigmoid and ileoileal knotting have been described in the literature. The postoperative course of our patient was uneventful and he was discharged from the hospital on the 15th postoperative day. One year later he still remains without symptoms from his intestinal tract.
  
  
  CONCLUSIONS
  Simultaneous ileosigmoid and ileoileal knotting is a very rare entity that should be diagnosed and treated surgically on an emergency basis to minimize the high postoperative morbidity and mortality.
authors.affiliation: Department of General Surgery, Athens "Polykliniki" General Hospital, 10A Glafkis str, GR-15232 Halandri, Athens, Greece. andromanakos@ath.forthnet.gr.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Andromanakos
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Filippou
authors.forename: Stamatis
authors.initials: S
authors.lastname: Pinis
authors.forename: Alkiviadis
authors.initials: A
authors.lastname: Kostakis
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D006801:Humans; D007077:Ileal Diseases / Q000175:diagnosis* / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D045822:Intestinal Volvulus / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D012810:Sigmoid Diseases / Q000175:diagnosis* / Q000601:surgery