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Ileosigmoid knotting: an unusual cause of acute intestinal obstruction with bowel gangrene
  1. Raj Kumar,
  2. Pavan Kumar Shamanur Kenchappa,
  3. Kusum Meena and
  4. Brijesh Kumar Singh
  1. Surgery, Lady Hardinge Medical College, New Delhi, Delhi, India
  1. Correspondence to Dr Brijesh Kumar Singh, brijeshkumarsinghssmc04{at}


Ileosigmoid knotting (ISK) is a rare cause of intestinal obstruction rapidly progressing to bowel gangrene. It is characterised by the wrapping of loops of ileum and sigmoid colon around each other. The condition often remains undiagnosed preoperatively; however, it can be suspected by the triad of small bowel obstruction, radiographic features suggestive of predominately large bowel obstruction and inability to deflate the intestine by a sigmoidoscope. We are reporting a case of 56-year-old man who presented with features of acute intestinal obstruction and compensated shock within 24 hours of onset of symptoms. Exploratory laparotomy revealed ISK resulting in gangrene of ileum and sigmoid colon. In view of haemodynamic instability, end ileostomy was done after excising gangrenous segments. The patient improved and stoma closure and ileocolic anastomosis were done after 3 months in follow-up.

  • gastrointestinal system
  • emergency medicine
  • general surgery

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  • Contributors BKS and RK: collected the clinical details and photographs of the patient’s report. PKSK, RK, KM and BKS: clinical management. BKS and PKSK: performed the literature review and drafted the initial manuscript. KM and RK: verified the diagnosis and other scientific facts. KM and RK: revised the manuscript critically for important intellectual content. All the authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.No grant was received for this report.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.


  • Patient consent for publication Obtained.