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).