The ileosigmoid knot: new observations and changing trends.

PURPOSE: Ileosigmoid knot is a rare surgical emergency. Most previous publications are either retrospective reviews of hospital records or sporadic case reports. Personal experience with this condition is often limited to one or two cases. This article describes the personal experience with this rare condition of a single author. This seems to be the largest reported prospective study of ileosigmoid knot.

METHODS: Seven patients with ileosigmoid knot were treated during a period of three years.

RESULTS: Ileosigmoid knot was common in males in their fourth decade. Mean duration of symptom was 22 hours. Correct preoperative diagnosis was possible in 71 percent of cases. The knot was successfully unraveled in 71 percent of cases. Sigmoid colon was gangrenous in all the patients (100 percent), whereas the ileum was gangrenous in only 43 percent of cases. There was no correlation between duration of symptoms and incidence of gangrene. After resection of gangrenous intestine, primary anastomosis was done in all patients. There were no deaths. The mean hospital stay was 14 days.

CONCLUSIONS: Correct preoperative diagnosis of ileosigmoid knot is possible when clinical, radiologic, and sigmoidoscopic features are considered together. Unraveling of the knot seems to be beneficial in ileosigmoid knot except when both components of the knot are frankly gangrenous. Primary anastomosis (ileoileal and/or colocolic) of resected gut seems to be a safe and better alternative in the management of ileosigmoid knot.