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
