ILEOSIGMOID KNOTTING IN TURKEY - REVIEW OF 68 CASES

PURPOSE: The high mortality associated with ileosigmoid knotting promp ted us to review the collected experiences of three university hospita ls in order to establish a more rational approach to the problem. METH OD: The clinical records of 68 patients with ileosigmoid knotting from 1970 to 1990 were reviewed with respect to incidence, etiopathogenesi s, clinical features, treatment, and clinical outcome. RESULTS: The mo st common type of ileosigmoid knotting was Type IA (48.5 percent), in which the active ileum encircled the passive sigmoid in a clockwise ma nner. Fifty (73.5 percent) patients developed a gangrenous bowel where as 18 patients did not show any definite evidence of impairment of bow el viability. En bloc removal of gangrenous knot and reestablishment o f intestinal continuity by enteroenteric or enterocolic anastomosis co mbined with the Hartmann procedure, which was employed in 20 (42.6 per cent) cases, constituted the most frequently preferred operation. The mortality rate in this series was 30.9 percent (21/68) and toxic shock , which ultimately resulted in multiple organ failure, was the major c ause of death. It was remarkable to note that there was an inverse cor relation between the duration of symptoms and the mortality rate refle cting the dramatic rapidity and severity of symptoms due to tightness of the knot which led to early and extensive gangrene, thus inevitably urged the patients to seek medical help without delay. CONCLUSION: Th e performance of prompt, individualized surgical treatment in conjunct ion with the use of advanced measures of critical care to combat the d isastrous consequences of multiple organ failure would contribute grea tly to improve survival rate in victims of this dreadful entity.