A Case of Ileosigmoid Knot that Prevented Short Bowel Syndrome

Abstract

An 84-year-old man was brought to our hospital with a 5-hour history of abdominal pain and vomiting. Since computed tomography showed a closed loop, a strangulated obstruction was diagnosed, and emergency surgery was performed. The small intestine and sigmoid colon formed a nodule, called an ileosigmoid knot. In particular, the small intestine was extensively entangled in the sigmoid colon and was necrotic. The strangulation was released, and the extent of necrosis was confirmed, because there was concern about short bowel syndrome caused by en bloc resection of the small intestine. The small intestine and sigmoid colon were quickly resected and anastomosed. The remaining small intestine was shortened to 130 cm, but the patient was discharged without developing short bowel syndrome. Ileosigmoid knots with necrosis often require extensive small bowel resection. En bloc resection of the small intestine without relieving strangulation is associated with short bowel syndrome and a significant risk of impaired postoperative quality of life. If the remaining small intestine is expected to be short, the strangulation should be released, and minimizing the extent of resection should be considered when the patient's general condition permits.