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      Ileosigmoid knotting: One of the largest single-center series

      brief-report

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          Abstract

          Ileosigmoid knotting (ISK) is the wrapping of the ileum or sigmoid colon around the base of the other structure, causing a double-loop intestinal obstruction. The disease generally presents as an intestinal obstruction with volvulus triad, including abdominal pain/tenderness, distention, and obstipation. Abdominal X-ray findings are not pathognomonic, and computerized tomography (CT) and magnetic resonance imaging (MRI) are more useful in the diagnosis. A patient with ISK generally requires an emergency laparotomy following resuscitation. Based on the viability of the ileum and sigmoid colon, different resectional or non-resectional surgical techniques may be used. In this report, one of the largest single-center ISK series in the world, an eighty-case series, is concisely presented.

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          Most cited references14

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          Ileosigmoid knotting in Turkey. Review of 68 cases.

          The high mortality associated with ileosigmoid knotting prompted us to review the collected experiences of three university hospitals in order to establish a more rational approach to the problem. The clinical records of 68 patients with ileosigmoid knotting from 1970 to 1990 were reviewed with respect to incidence, etiopathogenesis, clinical features, treatment, and clinical outcome. The most common type of ileosigmoid knotting was Type IA (48.5 percent), in which the active ileum encircled the passive sigmoid in a clockwise manner. Fifty (73.5 percent) patients developed a gangrenous bowel whereas 18 patients did not show any definite evidence of impairment of bowel viability. En bloc removal of gangrenous knot and reestablishment of intestinal continuity by enteroenteric or enterocolic anastomosis combined with the Hartmann procedure, which was employed in 20 (42.6 percent) cases, constituted the most frequently preferred operation. The mortality rate in this series was 30.9 percent (21/68) and toxic shock, which ultimately resulted in multiple organ failure, was the major cause of death. It was remarkable to note that there was an inverse correlation between the duration of symptoms and the mortality rate reflecting the dramatic rapidity and severity of symptoms due to tightness of the knot which led to early and extensive gangrene, thus inevitably urged the patients to seek medical help without delay. The performance of prompt, individualized surgical treatment in conjunction with the use of advanced measures of critical care to combat the disastrous consequences of multiple organ failure would contribute greatly to improve survival rate in victims of this dreadful entity.
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            Volvulus of the Small Bowel and Colon.

            Volvulus of the intestines may involve either the small bowel or colon. In the pediatric population, small bowel volvulus is more common, while in the adult population, colonic volvulus is more often seen. The two most common types of colonic volvulus include sigmoid and cecal volvulus. Prompt diagnosis and treatment is imperative, otherwise bowel ischemia may ensue. Treatment often involves emergent surgical exploration and bowel resection.
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              Treatment for ileosigmoid knotting: a single-center experience of 74 patients.

              Ileosigmoid knotting (ISK) is the wrapping of the ileum around the base of the sigmoid colon. The purpose of this study was to investigate the outcomes for patients undergoing various treatments for ISK.
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                Author and article information

                Journal
                Pak J Med Sci
                Pak J Med Sci
                Pakistan Journal of Medical Sciences
                Professional Medical Publications (Pakistan )
                1682-024X
                1681-715X
                May-Jun 2018
                : 34
                : 3
                : 671-675
                Affiliations
                [1 ]Prof. Sabri Selcuk Atamanalp, MD. Department of General Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
                Author notes
                Correspondence: Prof. Sabri Selcuk Atamanalp, MD, Department of General Surgery, Faculty of Medicine, Ataturk University, 25040, Erzurum, Turkey. Email: ssa@ 123456atauni.edu.tr
                Article
                PJMS-34-761
                10.12669/pjms.343.14893
                6041517
                7699d1d6-7e52-49f8-8095-a51620651f16
                Copyright: © Pakistan Journal of Medical Sciences

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 20 February 2018
                : 28 May 2018
                Categories
                Short Communication

                ileum,intestinal obstruction,knotting,series,sigmoid colon
                ileum, intestinal obstruction, knotting, series, sigmoid colon

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