ILEOSIGMOID KNOTTING: A ZIMBABWEAN CASE SERIES.

BACKGROUND: Ileosigmoid knotting is a rare cause of intestinal obstruction with a rapidly progressive course, for which expedient surgical intervention is required to avoid mortality.

METHOD: A combined retrospective and prospective analysis was performed on 16 patients operated on at PGH with an operative diagnosis of ileosigmoid knotting between February 2011 and April 2016. Data inclusive of demographics, time to presentation and surgery, preoperative diagnostic accuracy, incidence of septic shock and mortality was collected.

RESULTS: The average age was 37.1 years (range 20-59 years) with a 4.3:1 male to female ratio. Two of the three females were pregnant. Thirteen patients (81.3%) experienced acute onset abdominal pain while asleep. The mean duration of symptoms prior to arrival at PGH was 10.8 hours (range 1-23hours). At admission, four patients (25%) were hypotensive (three more developing hypotension by the time of anaesthetic induction). Nine patients (56%) had leukocytosis and nine patients (56%) had deranged biochemical parameters. The most common preoperative diagnosis was sigmoid volvulus (50%), with no patients having a pre-operative diagnosis of ileosigmoid knotting. All patients had small bowel and sigmoid colon resection and Hartmann's procedure performed due to the presence of gangrene. Six patients (40%) required inotropic support for septic shock, while 57% of patients required transfusion. There was one perioperative death.

CONCLUSION: The diagnosis of ileosigmoid knotting needs to be considered in the young male or pregnant female patient with acute nocturnal onset abdominal pain and a rapidly deteriorating clinical course, and with radiological features suggestive of sigmoid volvulus.