Ileosigmoid Knot—Unveiling the Diagnostic Dilemma with Radiologic Signs: A Case Report

Abstract

Ileosigmoid knot (ISK) is an unusual and serious condition that is known to pose a diagnostic dilemma due to overlapping features of acute closed-loop intestinal obstruction. Early diagnosis and intervention are of immense importance in this condition because they can prove life threatening with rapid progression to gangrene of both the ileum and sigmoid colon. We report a case of a 27-year-old man who presented 2 days post-appendicectomy procedure with acute abdominal pain, abdominal distention, and hypovolemic shock. Initial evaluation with ultrasonography (USG) and abdominal X-ray was performed, which revealed pleural effusion, ascites, and an ahaustral dilated large bowel loop in the right upper abdomen with convergence in the left lower abdomen. Further imaging with computed tomography revealed closed-loop obstruction of the sigmoid colon with beaked appearance of its afferent and efferent limbs in the pelvis. There was associated whirling or knotting of the ileum around the sigmoid pedicle along with features of mesenteric ischemia. Emergency laparotomy was performed, which revealed ISK with gangrene of the ileal and large bowel loops.

Keywords

ileosigmoid knot - intestinal obstruction - bowel gangrene - whirl sign

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