Small Bowel Obstruction Due to Ileo-Ileal Knotting: Case Report

Abstract

Acute small bowel obstruction is an ever-increasing clinical problem. Small bowel obstruction is one of the most common causes of emergency admission with abdominal pain often requiring surgical intervention. Successful management depends on comprehensive knowledge of etiology and pathophysiology of small bowel obstruction, familiarity with imaging, good clinical judgement and sound technical skills. Intra-abdominal adhesions related to prior abdominal surgery accounts for up to 75% of small intestinal obstruction followed by hernias. Ileo ileal knotting is an extremely rare surgical entity with only few cases reported so far. Ileo-ileal knotting occurs when dynamic coil of ileum loops around another coil of ileum, which is relatively static, giving rise to a knot. Understanding of this uncommon phenomenon is very vital for early decision and intervention. In this instance, we describe a 70 years old man who presented with symptoms and signs of small bowel obstruction. Up on emergency exploratory laparotomy we discovered that the proximal loop of the ileum had knotted on the distal ileum resulting in frank gangrene of ileum up to 3cm from ileo-cecal valve. The patient underwent end-to-side ileo transverse anastomosis after the enbloc resection of gangrenous segment of the ileum.