Vadim Meytes, DO, Rebekah Campbell, MD, Sharon B Larson, DO, Dmitriy Karev, MD. NYU Lutheran Medical Center
Introduction: Ileosigmoid Knot (ISK) is a rare cause of bowel obstruction that leads to necrosis. In this condition, the ileum wraps around the sigmoid colon causing a knot and strangulation of both structures. ISK is extremely rare in North America; most cases are reported in Asia and Africa. Furthermore, ISK typically presents in adults in their fourth decade or older. Here we present a case of an ileosigmoid knot in a 14-year-old male.
Case Report: A 14-year-old male presented with a chief complaint of sharp abdominal pain of 2 hours duration associated with multiple episodes of vomiting. Past medical history included chronic constipation for which he eats a diet high in fiber in addition to using enemas regularly. On physical exam the patient was febrile and his abdomen was moderately distended with tympany, tenderness, guarding, and rebound tenderness. His white blood count was 25.7 k/ul and lactic acid level was 3.5 mmol/l. A CT scan of the abdomen and pelvis found markedly distended loops and thickened walls of small bowel in the mid-abdomen suspicious for midgut volvulus versus internal hernia. The patient was taken to the operating room for an exploratory laparotomy. Intra-operative findings included serosanguinous ascites with ischemic loops of distal small bowel and sigmoid colon. Involved portions of proximal and distal small bowel were resected along with the sigmoid colon. The remaining small bowel was anastomosed in a side-to-side fashion. The mesentery of small bowel was closed to prevent internal herniation. The proximal and distal sigmoid colon was anastomosed in a side-to-side fashion. The peritoneal cavity was irrigated and the abdomen was closed. Since his operation, our patient has been free of any complications and has advanced to a regular diet as tolerated.
Discussion: Ileosigmoid knot usually occurs in adult males in the fourth decade of life. There have been few reports of ISK in children. The specific etiology of ISK is not known. It is theorized that some anatomical features are involved in ISK including elongated small intestine mesentery, a hyper-mobile small intestine, and a redundant sigmoid colon. The small intestine descends and then wraps around the sigmoid colon causing early strangulation of both structures. Pre-operative diagnosis of ISK is difficult and should be considered when there is radiographic evidence of double closed-loop obstruction with the sigmoid being in the right upper quadrant and the small intestine being in the left upper quadrant.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 77706
Program Number: P132
Presentation Session: Poster (Non CME)
Presentation Type: Poster