Acute Ileosigmoid Knotting in an Adult: CT Diagnosis of a Rapidly Progressive Closed-Loop Volvulus

Ileosigmoid knotting (ISK) is a rare form of compound volvulus in which ileal loops wrap around the sigmoid colon or vice versa, producing a rapidly progressive closed-loop obstruction with a high risk of ischemia. Prompt computed tomography (CT) recognition is essential, as clinical findings are often non-specific, and deterioration can occur quickly. We report the case of a previously healthy adult who presented with abrupt, severe abdominal pain and progressive distension. CT revealed a double closed-loop configuration involving the distal ileum and sigmoid colon, a prominent whirlpool sign, reduced mural enhancement of ileal loops, mesenteric congestion, and localized free fluid. Emergency laparotomy confirmed ISK, with non-viable ileal segments requiring resection. The postoperative course was uneventful. This case highlights the critical role of CT in diagnosing ISK and identifying early signs of ischemia. Systematic assessment of anatomy, loop orientation, and enhancement characteristics is essential to expedite surgical management.