title: Ileosigmoid knotting-A disastrous double closed loop obstruction.
abstract: BACKGROUND
  Ileosigmoid knotting (ISK) is a rare entity which needs prompt recognition and immediate surgical intervention to avoid catastrophic complications caused by gangrenous bowel and subsequent peritonitis. Preoperative investigations are only diagnostic of obstruction and CT findings are helpful but are not always available.
  
  
  METHODS
  This case report describes a 22 year old male presenting with acute abdomen managed with emergency exploration in view of findings of peritonitis. Intra-operatively an ileal segment was wrapped around the base of sigmoid colon with gangrenous ileal segment suggesting ISK. Resection of gangrenous ileal segment with double barrel ileostomy was done. Patient tolerated procedure well.
  
  
  CONCLUSIONS
  Patients with ileosigmoid knotting present with frank obstruction and require immediate medical and surgical treatment. This condition rapidly progresses to gangrenous bowel, generalized peritonitis and sepsis with very high mortality.
  
  
  CONCLUSIONS
  Early diagnosis, prompt fluid resuscitation, preoperative antibiotics and immediate surgical exploration are keys for optimal management of this condition.
authors.affiliation: Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai Central, Mumbai 400008, India. Electronic address: manoj.bhambare@gmail.com.
authors.forename: Manoj
authors.initials: M
authors.lastname: Bhambare
authors.affiliation: Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai Central, Mumbai 400008, India. Electronic address: sudattaw@gmail.com.
authors.forename: Sudatta
authors.initials: S
authors.lastname: Waghmare
authors.affiliation: Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai Central, Mumbai 400008, India. Electronic address: drajeetramantiwari@gmail.com.
authors.forename: Ajeet
authors.initials: A
authors.lastname: Tiwari
authors.affiliation: Department of General Surgery, Topiwala National Medical College and Bai Yamunabai Laxman Nair Hospital, Mumbai Central, Mumbai 400008, India. Electronic address: smruti63@hotmail.com.
authors.forename: Jayashri
authors.initials: J
authors.lastname: Pandya
keywords: Gangrenous bowel; Ileosigmoid knotting; Ileostomy; Obstruction; Peritonitis