Ileosigmoid knot as a cause of acute abdomen at 28 weeks of pregnancy: A rare case report

Ileosigmoid knot (ISK) is an unusual clinical condition of small bowel obstruction in which the ileum twists around the base of the sigmoid colon and forms a pseudo-knot (1). Turkey, particularly Eastern Anatolia, where our hospitals are located, has a high incidence of this otherwise rare disease (2). The strangulation caused by the "knot" threatens the viability of both ileum and sigmoid colon (3). In severe cases, it can cause gangrene of both the small bowel and the sigmoid colon. Preoperative diagnosis of this condition is difficult due to its rarity and atypical radiographic findings (4). In recent years, computed tomography (CT) has emerged as a preoperative diagnostic tool. Generalized peritonitis and sepsis are the main causes of the poor outcome in patients with ISK. After hemodynamic stabilization, immediate surgical intervention is the only viable option in these patients (5). Treatment of ISK consists of early and effective resuscitation followed by emergency surgery, the purpose of which is to release the knot, resect the gangrenous bowel segment, resume intestinal continuity, and prevent recurrence (2). In this report, we present an unusual case of ISK in a patient who was in her late pregnancy and underwent emergency surgery for acute abdomen. Case report