Ileosigmoid knotting: a rare and life threatening case of acute bowel obstruction

Ileosigmoid knotting is a rare cause of acute intestinal obstruction, and is also known as compound volvulus or double volvulus. It occurs due to wrapping of the ileum or sigmoid colon around the base of the other, causing bowel obstruction. The bowel obstruction rapidly progresses to gangrene of the ileum as well as the sigmoid colon, generalized peritonitis and septic shock. It is a potentially lethal condition with high morbidity and mortality rates. The incidence of ileosigmoid knotting is rare and usually seen in areas where there is a high incidence of the sigmoid volvulus with male preponderance. The primary risk factor for ileosigmoid knotting is a long small bowel mesentery with a freely mobile small bowel and a redundant sigmoid colon on a narrow mesentery. We present the case of a 79-year-old male patient who presented with an acute abdomen at our emergency with signs of peritonism. Emergent surgical exploration was done given acute intestinal obstruction and peritonitis. Intra-operatively, ileosigmoid knotting was present with gangrenous ileum and sigmoid colon. Resection of gangrenous bowel was performed with end ileostomy and Hartmann's procedure for descending colon in view of haemodynamic instability.