CC BY-NC-ND 4.0 · Journal of Gastrointestinal and Abdominal Radiology 2019; 02(01): 053-057
DOI: 10.1055/s-0039-1677772
Case Report
Indian Society of Gastrointestinal and Abdominal Radiology

Ileosigmoid Knot—Unveiling the Diagnostic Dilemma with Radiologic Signs: A Case Report

Poonam Hegde
1  Department of Radiology and Imaging, Manipal Hospitals, Bangalore, Karnataka, India
,
Rupa Ananthasivan
1  Department of Radiology and Imaging, Manipal Hospitals, Bangalore, Karnataka, India
,
Sudarshan Rawat
1  Department of Radiology and Imaging, Manipal Hospitals, Bangalore, Karnataka, India
,
Pooja G. Patil
1  Department of Radiology and Imaging, Manipal Hospitals, Bangalore, Karnataka, India
,
Bhavana Girishekar
1  Department of Radiology and Imaging, Manipal Hospitals, Bangalore, Karnataka, India
,
Mrinal Matish
1  Department of Radiology and Imaging, Manipal Hospitals, Bangalore, Karnataka, India
› Author Affiliations
Further Information

Publication History

Received: 30 August 2018

Accepted after revision: 28 October 2018

Publication Date:
24 June 2019 (online)

  

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.