Ileosigmoid Knotting: A Rare Cause of Intestinal Obstruction and Bowel Ischemia—Case Report with Literature Review

Figures & data

Figure 1 White arrows indicate the closed sigmoid loop.

Figure 2 Gangrenous closed-loop sigmoid.

Figure 3 White arrows indicate ileum knot on sigmoid mesentery; blue arrow indicates gangrenous sigmoid.

Table 1 Ileosigmoid Knot Classification

Type I	The ileum (active component) wraps itself around the sigmoid colon (passive component) in a clockwise or anticlockwise direction.	(Type A when clockwise and type B when anticlockwise).
Type II	The sigmoid colon (active component) wraps itself around a loop of ileum (passive component) in a clockwise or anticlockwise direction.
Type III	The ileocecal segment (active component) wraps itself around the sigmoid colon (passive component).

Notes: Reproduced from Alver O, Oren D, Tireli M, Kayabaşi B, Akdemir D. Ileosigmoid knotting in Turkey. Review of 68 cases. Dis Colon Rectum. 36(12):1139–1147. https://doi.org/10.1007/BF02052263⁶

Table 2 New Classification of Ileosigmoid Knot Proposed by Atamanalp

C1	C2		C3		C4		C5	C6
	C2a	C2b	C3a	C3b	C4a	C4b
A0 D0	One of A, D1 Either older 60 years or present of associated diseases	Two of A, D1 older 60 years and present of associated diseases	One of A, D1 Either older 60 years or present of associated diseases	Two of A, D1 older 60 years and present of associated diseases	One of A, D1 Either older 60 years or present of associated diseases	Two of A, D1 older 60 years and present of associated diseases
S0	S0 Shock absent	S0 Shock absent	S1 Shock present	S1 Shock present	S0 Shock absent	S0 Shock absent	S1 Shock present
G0	G0 Bowel gangrene absent	G0 Bowel gangrene absent	G0 Bowel gangrene absent	G0 Bowel gangrene absent	G1 Bowel gangrene in ileum or sigmoid	G1 Bowel gangrene in ileum or sigmoid	G1 Bowel gangrene in ileum or sigmoid	G2 Bowel gangrene in ileum and sigmoid

Notes: Copyright ©2009 John Wiley and Sons. Adapted from S. Selçuk ATAMANALP, Gürkan ÖZTÜRK, Bülent AYDINLI, M. İlhan YILDIRGAN, Mahmut BAŞOĞLU, Durkaya ÖREN MK. A new classification for ileosigmoid knotting. Turk J Med Sci. 2009;39(4):541–545.⁷ C (Class). A (Age): A0: under 60 years; A1: 60 years and older. D (Associated disease): D0: absent, D1: present. S (Shock): S0: absent, S1: present. G (Bowel gangrene): G0: absent, G1: present in the ileum or sigmoid colon, G2: present in both segments.

Alver O, Oren D, Tireli M, Kayabaşi B, Akdemir D. Ileosigmoid knotting in Turkey. Review of 68 cases. Dis Colon Rectum. 1993;36(12):1139–1147. doi:10.1007/bf02052263

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Atamanalp SS, Oeztuerk G, Aydinli B, et al. A new classification for ileosigmoid knotting. Turk J Med Sci. 2009;39(4):541–545. doi:10.3906/sag-0810-1

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