Ileoileal Knotting as a Rare Cause of Acute Small Bowel Obstruction: Report of a Case with Review of Literature

Background: Small bowel obstruction is an acute surgical disease necessitating urgent diagnosis and intervention. Ileoileal knotting is a rare condition that can result in acute bowel obstruction and gangrene whereas ileosigmoid knotting is a relatively common surgical condition. There are few published studies so far on ileoileal knotting. Due to the scarcity of ileoileal knotting cases that have been published, the exact causes are not well known. We presenta rare case of small bowel obstruction which was managed successfully and had an uneventful postoperative period. Case: A 45-year-old farmer from the rural kebele of Goba district of Bale Zone visited our institution with a complaint of sudden, colicky pain of 6 hours duration. On presentation, the pain was localized to the periumbilical area and then involved the whole abdomen. Associated with this, he had vomiting of ingested matter of three episodes. Objectively, he was in severe pain and tachycardic. On abdominal examination, there was direct and rebound tenderness over the periumbilical region. Abdominopelvic ultrasound revealed long segment ileoileal intussusception with adjacent mesenteric significant edema and proximal small bowel loop dilatation which was later found to be ileoileal knotting intraoperatively. The patient was put on intravenous fluid and antibiotics with a diagnosis of acute abdomen secondary to ileoileal knotting at the surgical emergency department. Exploratory laparotomy plus resection plus end to side ileotransverse anastomosis was done after written informed consent was received. Conclusion: Ileoileal knotting is a rare condition that can result in acute bowel obstruction and gangrene. The diagnosis is usually made intraoperatively even though proper history, laboratory tests, and imaging are quite helpful. Clinicians should have a high index of suspicion of bowel knotting in patients with an acute abdomen and take early interventions to reduce the risk of gangrene.