Double ileocolic obstruction: Emergency management lessons from a resource-limited region

Introduction :Ileosigmoid knotting (ISK) is a rare and potentially life-threatening form of intestinal obstruction.Case report : We describe a 47-year-old patient from Tunisia, the second documented case nationally, presenting with acute abdominal pain and vomiting initially attributed to adhesive small bowel obstruction. Limited imaging resources in local hospital necessitated transfer to another facility, delaying surgical intervention. Exploratory laparotomy revealed a non-viable ISK , which was resected. Conclusion : This case highlights two key lessons: On a systemic level, shortages in diagnostic tools and intensive care capacity within public hospitals can negatively impact prognosis in rare but life-threatening emergencies. On a clinical level, emergency physicians and surgeons must maintain vigilance, and act decisively even in constrained environments. Greater awareness of rare entities such as ISK can lead to timely surgical intervention and potentially improve outcomes.1. Atamanalp SS. Ileosigmoid knotting: An update for Atamanalp classification. Pak J Med Sci. 2021;37(3):913‑5. 2. Atamanalp SS, Disci E, Peksoz R, Atamanalp RS, Atamanalp CT. Ileosigmoid knotting: A review of 923 cases. Pak J Med Sci. 2022;38(3Part-I):711‑5. 3. Zenati H, Chaouch MA, Zayeti M, Beltaifa R, Gafsi B, Noomen F. A rare case report of ileosigmoid knots that cause intestinal obstruction during Ramadan fasting. International Journal of Surgery Case Reports. janv 2025;126:110725. 4. Argaw DA, Nur WA, Ibrahim MA, Hassan MA, Mohamud AA, Ayen AA. Ileosigmoid knotting: A rare cause of acute abdomen with fatal outcome in a 60-year-old man: Case report from a resource-limited setting. Int J Surg Case Rep. août 2025;133:111641.