Ileo-Sigmoid Knot: An Uncommon Surgical Emergency

The ileo-sigmoid knot (ISK) is a rare but life-threatening surgical emergency characterized by the simultaneous volvulus of the ileum and sigmoid colon, leading to acute intestinal obstruction. It is more common in certain regions of Africa, Asia, and the Middle East, with approximately 1,000 cases reported worldwide. We report the case of a 50-year-old female with no significant past medical history who presented with symptoms of intestinal obstruction. Physical examination revealed abdominal distension and tenderness, and abdominal CT scan demonstrated the classic ‘whirl sign’ indicative of ISK with suspected ileal necrosis. Emergency laparotomy confirmed a double volvulus with necrosis of 2 meters of the ileum and a viable sigmoid colon. Surgical management involved resection of the necrotic ileal segment followed by primary anastomosis and sigmoidopexy. Prompt diagnosis and surgical intervention are critical in managing ISK to prevent bowel necrosis and associated morbidity. Abdominal CT is essential for early detection, and treatment strategies depend on bowel viability. This case underscores the importance of considering ISK in patients presenting with acute intestinal obstruction, especially in regions with a higher prevalence.