Ileo-sigmoid knotting: the Parirenyatwa hospital experience

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dc.contributor.authorMbanje, C.
dc.contributor.authorMungazi, S.G.
dc.contributor.authorMuchuweti, D.
dc.contributor.authorMazingi, D.
dc.contributor.authorMlotshwa, M.
dc.contributor.authorMaunganidze, A.J.V.
dc.date.accessioned2025-05-28T09:42:15Z
dc.date.available2025-05-28T09:42:15Z
dc.date.issued2020
dc.description.abstractBackground: Ileo-sigmoid knotting is a rare cause of intestinal obstruction with a rapidly progressive course, for which expedient surgical intervention is required to prevent mortality. The aim of this study was to determine the characteristics, presentation, morbidity and mortality associated with ileo-sigmoid knotting at Parirenyatwa Group of Hospitals (PGH). To determine the preoperative diagnostic precision and management patterns of ileo-sigmoid knotting cases at PGH. Methods: A retrospective analysis was performed on patients operated on at Parirenyatwa Hospital with a diagnosis of ileo-sigmoid knotting between April 2011 and April 2018. Data inclusive of demographics, time to presentation and surgery, preoperative diagnosis, complications and in-hospital mortality was collected. The relationship between the duration of symptoms prior to surgery and incidence of both septic shock and transfusion were analysed. Results: Twenty-one cases of ileo-sigmoid knotting were identified for analysis. The median age was 37 years (range 18–65 years) with a 6: 1 male to female ratio. Two of the three females included were pregnant. Twenty patients (95.2%) described an acute onset abdominal pain, with 83.3% experiencing the pain nocturnally, while asleep. The median duration of symptoms at presentation was 12.5 hours (range 2–39 hours). At admission, leucocytosis (WCC> 11x10³/dl) was noted in eleven patients (52.4%). Seventy-three per cent of patients were noted to have electrolyte derangements at presentation. Seven patients (33.3%) had recorded episodes of severe hypotension (SBP< 90) prior to surgery. The most common preoperative diagnosis, based on both clinical assessment and plain x-ray evaluation, was sigmoid volvulus (52.4%), with no preoperative diagnosis of ileo-sigmoid knotting being made. All patients had gangrenous small bowel, with 81% having a gangrenous sigmoid colon. All cases underwent small bowel resection and primary anastomosis plus Hartmann’s procedure. Postoperatively, eleven patients (52.4%) developed septic shock, while 62% required blood transfusion. There was one (4.8%) early postoperative mortality. Conclusion: To avoid mortality, the diagnosis of ileo-sigmoid knotting should be entertained and the imperative of emergency surgery recognised in the young male or pregnant female patient with acute nocturnal onset abdominal pain, a rapidly deteriorating small bowel obstruction clinical picture and with radiological features suggestive of both small and large bowel obstruction.
dc.identifier.citationMbanje, C., Mungazi, S.G., Muchuweti, D., Mazingi, D., Mlotshwa, M. and Maunganidze, A.J.V., 2020. Ileo-sigmoid knotting: the Parirenyatwa hospital experience. South African Journal of Surgery, 58(2), pp.70-73.
dc.identifier.issn038-2361
dc.identifier.urihttp://196.220.97.103:4000/handle/123456789/693
dc.language.isoen
dc.publisherSouth African Journal of Surgery
dc.titleIleo-sigmoid knotting: the Parirenyatwa hospital experience
dc.typeArticle
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