3 Discussion
Intestinal knot syndromes occur when part of an intestine wraps around
the base of a loop of another bowel. The most common variety is
ileosigmoid knotting which occurs when an ileum wraps around the base of
the sigmoid and passes beneath itself forming a knot. The earliest
reported case was that of Parker in 1845, entitled, ”Case of Intestinal
Obstruction: Sigmoid Flexure Strangulated by the Ileum(2).
Since then there are a lot of reports of iliosigmoid knotting in world
literature especially from Africa including Ethiopia(7).
The other rarer varieties are ileoileal knots and appendiculoileal
knotting. We are here reporting another type of knotting that were
reported only twice in world literature(8). The first report was in 2007
by Tulsi Menon and colleagues(9) and the other was by Arkaprovo Roy et
al from Kolkata, India in 2011(10).
Intestinal obstruction by knotting is a very dangerous acute abdominal
condition resulting in the development of gangrene in both loops of
bowel involved in a short time. Our patient presented with a two days
duration of symptoms in a state of shock and had majority of small
bowel, cecum and ascending colon gangrenous(3).
In this patient in addition to ileum most of jejunum was involved in
wrapping around the mobile cecum and ascending colon and all these
structures were found to be gangrenous. There were only 40 cm of viable
jejunum remaining and anastomosis between jejunum and transverse colon
has to be done.
The presence of a mobile cecum and ascending colon is known to
predispose to mid gut volvulus as well as knotting by ileum and
appendix(11,12).
The patient developed symptoms of short bowel syndrome which was
aggressively treated with fluid and electrolyte replacement as well as
parenteral hyper alimentation.
Short bowel syndrome in adult is often the consequence of repeated
resections for inflammatory bowel disease and occasionally for a
gangrenous small bowel volvulus or mesenteric ischemia and has not been
reported for intestinal knot syndromes(13).