World Journal of Surgery

, Volume 31, Issue 1, pp 31–35 | Cite as

Ileosigmoidal Knotting in Children: A Review of 9 Cases

  • S. Selçuk AtamanalpEmail author
  • Durkaya Ören
  • M. İlhan Yildirgan
  • Mahmut Başoğlu
  • Bülent Aydinli
  • Gürkan Öztürk
  • Bedii Salman



The purpose of this study was to review nine pediatric cases of ileosigmoidal knotting (ISK), which is an unusual form of intestinal obstruction common in adults, characterized by double-loop obstruction.


A retrospective analysis was designed to examine preoperative, operative, and postoperative findings of the nine children with ISK who were surgically treated in a university hospital throughout a 38.5-year period..


The mean age was 10.6 years (range: 7–16 years). Seven patients (77.8 %) were male. The most common symptoms were abdominal pain, distention, obstipation, and vomiting, and the most common signs were abdominal tenderness and distention. The most common form was type 1A in 4 patients (44.4%) in whom the active ileum encircled the passive sigmoid colon in clockwise direction. There was a gangrene in both ileum and sigmoid colon in 7 patients (77.8%), one patient (11.1%) had gangrene in only the sigmoid colon, and the bowels were viable in 1 patient (11.1%). In the gangrenous cases, nonviable small bowel segments were resected, and anastomosis was performed, while gangrenous sigmoid colon was resected and Hartmann procedure or primary anastomosis was used. In the nongangrenous case, detorsion was performed and sigmoidopexy was added. One patient in this series (11.1%) died.


Ileosigmoidal knotting is a rare disease in children. Its preoperative diagnosis is not easy. It is generally misdiagnosed as an obstructive emergency. Aggressive preoperative resuscitation, effective and prompt surgery, and postoperative support are the basic principles of treatment. Although resection with primary anastomosis is advised in gangrenous cases, stomas may be lifesaving in unstable patients. In nongangrenous cases, definitive surgical procedures are generally used.


Sigmoid Colon Short Bowel Syndrome Primary Anastomosis Ileal Loop Large Bowel Obstruction 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Société Internationale de Chirurgie 2006

Authors and Affiliations

  • S. Selçuk Atamanalp
    • 1
    Email author
  • Durkaya Ören
    • 1
  • M. İlhan Yildirgan
    • 1
  • Mahmut Başoğlu
    • 1
  • Bülent Aydinli
    • 1
  • Gürkan Öztürk
    • 1
  • Bedii Salman
    • 2
  1. 1.Department of General SurgeryAtatürk University School of MedicineErzurumTurkey
  2. 2.Department of Pediatric SurgeryAtatürk University School of MedicineErzurumTurkey

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