Clinical profile and treatment outcome of patients with ileo-sigmoid knotting, an experience from Ethiopian setting: a six years review

Abstract

BACKGROUND: Ileo-sigmoid knotting (ISK) is a rare cause of intestinal obstruction, characterized by the twisting of the ileum around the sigmoid colon or vice versa. This study aimed to assess the clinical characteristics and treatment outcomes of patients undergoing laparotomy for ISK at a tertiary hospital in Ethiopia. METHODS: This is an institution based cross sectional study conducted at Debre Markos Comprehensive Specialized Hospital in Debre Markos City, Northwest Ethiopia. A six-year study was conducted at Debre Markos Comprehensive Specialized Hospital by revewing the medical records of 42 patients operated for ISK between March 31, 2018, and April 1, 2024. Data were extracted, processed, and analyzed using Epi-Data 4.6 and STATA 17.0. Fisher's exact test was used to determine statistical significance (p-value ≤ 0.05). RESULTS: Thirty-eight patients (90.5%) had complete medical records, with a mean age of 39.2 years (SD ± 10.2) and a male predominance (M: F = 3.2:1). Accurate preoperative diagnosis was achieved in only 5.3% of cases, with the majority being misdiagnosed as small or large bowel obstruction. Gangrene of both the ileum and sigmoid colon was observed in 71.1% of cases. The most commonly performed procedure (68.4%) was resection of both segments with primary ileo-ileal and colorectal anastomosis. Postoperative complications occurred in 52.6% of patients, the most common one being anemia (31.6%). Mortality was 7.9% and was significantly associated with anastomotic leaks (p = 0.045). The average hospital stay was 8.2 days (IQR: 6-37). CONCLUSIONS AND RECOMMENDATION: The accuracy of preoperative diagnosis of ileo-sigmoid knotting in this study is lower. However, ileo-sigmoid knotting had high postoperative morbidity and mortality. This study highlights the need for heightened awareness for preoperative diagnosis and prompt surgical treatment. We recommend a prospective multicentric study to guide on appropriate operative decision making in ISK patients.