title: Ileo-sigmoid knotting: a review of 61 cases in Kenya.
abstract: BACKGROUND
  Ileo-sigmoid knotting (ISK) is a rare cause of bowel obstruction in which the ileum twists around the sigmoid colon. It is associated with rapid bowel gangrene and a high mortality rate. Little has been published about this condition in Kenya. The objective was to determine the presentation, management, and outcome of patients with ISK.
  
  
  METHODS
  A seven year (January 2008-December 2014) retrospective chart review of patients managed for ISK at Tenwek Hospital in Bomet, Kenya.
  
  
  RESULTS
  A total of 61 cases were identified, with a mean age of 35.8 years (range 2-68), and mean symptom duration of 1.6 days (range 3 hours-7 days). Gangrene was noted to involve both the ileum and colon in 45 patients, the ileum only in 9 patients, and the sigmoid colon only in one. Resection and primary anastomosis was carried out in most cases of gangrenous ileum (48/54, 89%) and gangrenous sigmoid colon (34/46, 74%), while resection and stoma was performed in 8 patients with gangrenous colon. Death occurred in 7 (11.5%) patients due to severe sepsis and multisystem organ failure. Morbidities were noted in 15 (24.6%) patients, including surgical site infection (8, 13.1%), respiratory insufficiency (4, 6.6%), fascial dehiscence (3, 4.9%) and anastomotic leak (2, 3.2%). The mean duration of hospitalization was 8.3 days (range 1-26).
  
  
  CONCLUSIONS
  In this review, though retrospective in nature, ISK was noted to have high rates of bowel gangrene. In the appropriate setting, resection and primary anastomosis can be safely carried out in most cases of gangrenous colon.
authors.affiliation: Department of Surgery, Tenwek Hospital, Bomet, Kenya.
authors.forename: Philip Blasto
authors.initials: PB
authors.lastname: Ooko
authors.affiliation: Department of Surgery, Tenwek Hospital, Bomet, Kenya.
authors.forename: Seno
authors.initials: S
authors.lastname: Saruni
authors.affiliation: Department of Surgery, Tenwek Hospital, Bomet, Kenya.
authors.forename: Mark
authors.initials: M
authors.lastname: Oloo
authors.affiliation: Department of Surgery, Tenwek Hospital, Bomet, Kenya.
authors.forename: Hillary Mariko
authors.initials: HM
authors.lastname: Topazian
authors.affiliation: Department of Surgery, Tenwek Hospital, Bomet, Kenya.
authors.forename: Russell
authors.initials: R
authors.lastname: White
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003108:Colonic Diseases / Q000150:complications / Q000453:epidemiology / Q000601:surgery; D005260:Female; D005734:Gangrene / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007077:Ileal Diseases / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D007415:Intestinal Obstruction / Q000209:etiology; D045822:Intestinal Volvulus / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D007630:Kenya / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012810:Sigmoid Diseases / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D055815:Young Adult
keywords: Ileosigmoid knotting; intestinal obstruction; outcome; treatment; volvulus