Ileosigmoid Knotting: A Rare But Lethal Cause of Acute Intestinal Obstruction - A Narrative Review

Ileosigmoid knotting (ISK) is a rare and potentially fatal surgical emergency characterized by wrapping of the ileum around the sigmoid colon or vice versa, resulting in a closed-loop obstruction with rapid progression to strangulation and gangrene [1,2]. The condition is predominantly reported from regions with a high incidence of sigmoid volvulus and commonly affects adult males [3,4]. Preoperative diagnosis is challenging due to nonspecific clinical features and overlapping radiological findings with other causes of bowel obstruction [5,6]. Delayed presentation and limited access to advanced imaging further worsen outcomes, particularly in resource-limited settings [7]. Early recognition, aggressive resuscitation, and emergency surgical intervention are critical to reducing morbidity and mortality [2,8]. This review summarizes the epidemiology, etiopathogenesis, clinical presentation, diagnostic challenges, operative management, and outcomes of ileosigmoid knotting, with emphasis on evidence from published case series and reviews.