ILEOSIGMOID KNOTTING

Abstract

The purpose of this study is to present our patients and to discuss the causes of morbidity and mortality and to ascertain prognostic indices and therapeutic options influencing outcome of patients with ileosigmoid knotting in the light of literature. The clinical records of 16 patients, treated for ileosigmoid knotting at Dicle University Medical Faculty, Diyarbakır-Turkey, between January 1985-1995, were evaluated retrospectively. The most frequent complaints and signs were abdominal pain and distention, constipation, nausea and vomiting. At the time of operation, only ileal necrosis in 6, ileal and sigmoidal necrosis in 4, only sigmoid colon necrosis in 3 and both ileum and total colon necrosis in 2, while necrosis did not exist in 1 patient. Necrotic ileum and/or colon were resected in 15 patients. One patient without necrosis was treated by detorsion and mesosigmoplasty. Following small bowel resection, primary anastomosis was performed on 9 patients. Seven patients who had sigmoid resection were treated by primary colocolic anastomosis. Total colectomy and ileostomy were carried out in 2 patients with ileum and total colon necrosis. The mortality rate in this series was 18.7% (3/16) and toxic shock was the major cause of death. We believe that preoperative aggressive resuscitation and appropriate antibiotic combination, effective surgical attempt and postoperatively metabolic support by total parenteral nutrition appear to have contributed to significant decreases in morbidity and mortality.