Ileosigmoid knotting with gangrenous double segments in pregnancy: a rare cause of intestinal obstruction managed with a single laparotomy with favorable maternal and fetal outcome

Introduction and Importance: Ileosigmoid knotting (ISK) is a rare cause of intestinal obstruction, and it is associated with a poor prognosis with an adverse outcome for the mother and the fetus. It usually occurs in multiparous women during the third trimester of pregnancy. Case Presentation: A 41-year-old gravida-3, para-2 mother, amenorrheic for 7 months, presented with abdominal pain, vomiting, inability to pass feces and flatus, and abdominal distention of 8 hours duration. She was tachycardic and had abdominal tenderness on examination, and was also found to have leucocytosis with left shift. She was resuscitated and underwent laparotomy, which revealed ISK, with both segments were gangrenous. Resection of the ileum with ileo-transverse colon anastomosis and a sigmoid colon resection with primary colonic anastomosis were performed. The postoperative course was uneventful. Clinical discussion: ISK in pregnancy is rare, with adverse outcomes to the mother and fetus. Most cases were reported in multiparous women in their third trimester of pregnancy. Patients will present with symptoms of bowel obstruction with signs of peritonitis within a short period. The intraoperative decision depends on the viability of the bowel, the anatomic extent of knotting, and the intraoperative hemodynamic stability of the patient. Conclusion: A high index of suspicion is necessary to diagnose and initiate proper management in patients with ISK as early as possible, which impacts the outcome significantly. Resection of the gangrenous component followed by primary anastomosis of both segments could be performed with a successful outcome in pregnant mothers with ileosigmoid knotting.