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01.12.2014 | Case report | Ausgabe 1/2014 Open Access

Journal of Medical Case Reports 1/2014

An unusual synchronous ileosigmoid and ileoileal knotting: a case report

Journal of Medical Case Reports > Ausgabe 1/2014
Nikolaos Andromanakos, Dimitrios Filippou, Stamatis Pinis, Alkiviadis Kostakis
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1752-1947-8-200) contains supplementary material, which is available to authorized users.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

Our patient was admitted under the care of NA during this episode and was followed up in the outpatient clinic. NA was major contributor in writing the manuscript. DF, SP and AK contributed significantly to the editing of the manuscript and the review of the literature. All authors read and approved the final manuscript.



Ileosigmoid and ileoileal knotting are two rare entities. They usually present as acute abdomen and the diagnosis is established intraoperatively. The treatment is surgical and should be performed as soon as possible to decrease the incidence of perioperative mortality and morbidity.

Case presentation

We report an unusual case of a 26-year-old Argentine man with ischemic necrosis in parts of his small and large intestine due to combined ileosigmoid and ileoileal knotting. He had an ileal loop of ileum concurrently wrapped around the neck of a sigmoid volvulus and other loops of ileum strangulating them, forming two different tangles of tying. This very rare and unusual entity was diagnosed and managed intraoperatively during a diagnostic laparotomy performed on an emergency basis. Both the gangrenous small bowel loops and the affected sigmoid colon area were resected. The continuation of the intestinal tract was restored by primary end-to-end anastomoses. The present case is unusual and to the best of our knowledge no similar cases of simultaneous ileosigmoid and ileoileal knotting have been described in the literature. The postoperative course of our patient was uneventful and he was discharged from the hospital on the 15th postoperative day. One year later he still remains without symptoms from his intestinal tract.


Simultaneous ileosigmoid and ileoileal knotting is a very rare entity that should be diagnosed and treated surgically on an emergency basis to minimize the high postoperative morbidity and mortality.

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Reviewer acknowledgement

Reviewer acknowledgement 2013