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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
Article

Abstract

Background

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.

Methods

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..

Results

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.

Conclusions

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.

Keywords

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.

References

  1. 1.
    Akgun Y. Management of ileosigmoidal knotting. Br J Surg 1977;84:672–673CrossRefGoogle Scholar
  2. 2.
    Alver O, Oren D, Tireli M, et al. Ileosigmoidal knotting in Turkey. Dis Colon Rectum 1993;36:1139–1147PubMedCrossRefGoogle Scholar
  3. 3.
    Atamanalp SS, Oren D, Basoglu M, et al. Ileosigmoidal knotting: outcome in 63 patients. Dis Colon Rectum 2004;47:906–910PubMedCrossRefGoogle Scholar
  4. 4.
    Atamanalp SS, Yıldırgan MI, Basoglu M, et al. Sigmoid colon volvulus in children: review of 19 cases. Pediatr Surg Int 2004;20:492–495PubMedCrossRefGoogle Scholar
  5. 5.
    Chirdan LB, Ameh EA. Sigmoid volvulus and ileosigmoidal knotting inchildren. Pediatr Surg Int 2001;17:636–637PubMedCrossRefGoogle Scholar
  6. 6.
    Kedir M, Kotisso B, Messele G. Ileosigmoidal knotting in Gondar teachinghospital north-west Ethiopia. Ethiop Med J 1998;36:255–260PubMedGoogle Scholar
  7. 7.
    Meier D, Megison SM. Ileosigmoidal knotting in a 6-year-old child. PediatrSurg Int 1999;15:407–408PubMedCrossRefGoogle Scholar
  8. 8.
    Wolf B, Youngson GG. A case of ileosigmoidal knotting in a child. J PediatrSurg 1997;32:1514–1515PubMedCrossRefGoogle Scholar
  9. 9.
    Pahlman L, Enblad P, Rudberg C, et al. Volvulus of the colon. Acta Chir Scand 1989;155:53–56PubMedGoogle Scholar
  10. 10.
    Brothers TE, Strodel WE, Eckhauser FE. Endoscopy in colonic volvulus. Ann Surg 1987;206:1–4PubMedCrossRefGoogle Scholar
  11. 11.
    Öncü M, Piskin B, Calık A, et al. olvulus of the sigmoid colon. South Afr J Surg 1991;29:48–49Google Scholar
  12. 12.
    Mellor MFA, Drake DG. Colonic volvulus in children: value of barium enema for diagnosis and treatment in 14 children. AJR AM J Roentgenol 1994;162:1157–1159Google Scholar
  13. 13.
    Raveenthiran V. The ileosigmoidal knot: new observations and changing trends. Dis Colon Rectum 2001;44:1196–1200PubMedCrossRefGoogle Scholar
  14. 14.
    Shepherd JJ. Ninety-two cases of ileosigmoidal knotting in Uganda. Br JSurg 1967;54:561–566PubMedGoogle Scholar
  15. 15.
    Mehendale VG, Chaudhari NC, Mulchandani MH. Laparoscopic sigmoidopexy by extraperitonealization of sigmoid colon for sigmoid volvulus: two cases. Surg Laparosc Endosc Percutan Tech 2003;13:283–285PubMedCrossRefGoogle Scholar

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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