Ileo-Ileal Knotting; - A Case Report of 60-Year-Old Male Patient

Abstract

Tewodros Tadesse Tessema, Murtii Teressa Obolu, Abdullahi Mohamed, Tadesse Getachew Mulisa, Gebril Ahmed, Gediyon Getachew Gebo

Background: Ileo-Ileal knotting is a rare form of mechanical small bowel obstruction. Which is a classic closed loop obstruction syndrome. Even though the exact etiology is not known, prolonged fasting followed by sudden food overload with frequent peri- stalsis of Ileum in a muscular abdominal wall are documented predisposing factors for knotting of bowel in literature.

Case Presentation: Our patient was presented with a sudden onset of severe persistent crampy abdominal pain localized to all over abdomen associated with, multiple episodes of bilious vomiting, failure to pass faeces and flatus and low-grade fever of twelve hour. Otherwise, no history of abdominal trauma, no prior pertinent past surgical and medical history. Up on objective assessment he was acute sick looking, tachycardic, hypotensive, tachypnic, febrile, distended, tender abdomen and empty rectum on digital rectal examination.

Result: Patient was investigated with complete blood count and plain abdominal x-ray alongside with preoperative optimization and there was left shift leukocytosis on complete blood count test and centrally located multiple air fluid level with dilated bowel and absence of rectal gas shadow on plain abdominal x-ray. With impression of gangrenous small bowel obstruction secondary to small bowel volvulus patient was explored and intraoperatively gangrenous Ileo-Ileal knotting was diagnosed and enblock resection, Ileo-Ileal end-to-end anastomosis was done and post operatively patient outcome was satisfactory and doing well on follow up.

Conclusion: The gaol of surgical management is enblock resection of involved bowel segment proximal to the knot point with restoration of bowel continuity and strict control of systemic toxic substance and bacterial dissemination during resection. Mainly, outcomes depend on level of systemic sepsis dissemination and length of small bowel involved in the gangrenous knot.

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