Ileosigmoid knotting: a case report and review.

Ileosigmoid knotting, or compound volvulus, has not been reported previously in Australia. A 41 year old woman of Anglo-Saxon origin presented with a short history of extreme abdominal pain that was out of proportion to her physical findings. At operation it was found that her entire ileum was tightly knotted around the redundant, twisted sigmoid colon. Both closed loops were gangrenous and it was impossible to unravel the bowel. She recovered uneventfully following resection and primary anastomosis of both portions of the intestine. Most patients with this uncommon condition have been reported from Finland and eastern Africa. An arrangement of the small bowel and sigmoid colon on long, narrow mesenteries would appear to be a prerequisite. The brevity of the history and the severity of the abdominal pain call for early laparotomy. Prolonged attempts to untie the knot are dangerous. It is safer to divide the ileum at the knot and resect it in order to release the sigmoid colon. Primary anastomosis is feasible where the history is short and the uninvolved intestine is clean and collapsed.