Article ; Online: Ileo-sigmoid knotting: the Parirenyatwa hospital experience.
South African journal of surgery. Suid-Afrikaanse tydskrif vir chirurgie
2020 Volume 58, Issue 2, Page(s) 70–73
Abstract: Background: Ileo-sigmoid knotting is a rare cause of intestinal obstruction with a rapidly progressive course, for which expedient surgical intervention is required to prevent mortality. The aim of this study was to determine the characteristics, ... ...
Abstract | Background: Ileo-sigmoid knotting is a rare cause of intestinal obstruction with a rapidly progressive course, for which expedient surgical intervention is required to prevent mortality. The aim of this study was to determine the characteristics, presentation, morbidity and mortality associated with ileo-sigmoid knotting at Parirenyatwa Group of Hospitals (PGH). To determine the preoperative diagnostic precision and management patterns of ileo-sigmoid knotting cases at PGH. Methods: A retrospective analysis was performed on patients operated on at Parirenyatwa Hospital with a diagnosis of ileo-sigmoid knotting between April 2011 and April 2018. Data inclusive of demographics, time to presentation and surgery, preoperative diagnosis, complications and in-hospital mortality was collected. The relationship between the duration of symptoms prior to surgery and incidence of both septic shock and transfusion were analysed. Results: Twenty-one cases of ileo-sigmoid knotting were identified for analysis. The median age was 37 years (range 18-65 years) with a 6:1 male to female ratio. Two of the three females included were pregnant. Twenty patients (95.2%) described an acute onset abdominal pain, with 83.3% experiencing the pain nocturnally, while asleep. The median duration of symptoms at presentation was 12.5 hours (range 2-39 hours). At admission, leucocytosis (WCC > 11x10³/dl) was noted in eleven patients (52.4%). Seventy-three per cent of patients were noted to have electrolyte derangements at presentation. Seven patients (33.3%) had recorded episodes of severe hypotension (SBP < 90) prior to surgery. The most common preoperative diagnosis, based on both clinical assessment and plain x-ray evaluation, was sigmoid volvulus (52.4%), with no preoperative diagnosis of ileo-sigmoid knotting being made. All patients had gangrenous small bowel, with 81% having a gangrenous sigmoid colon. All cases underwent small bowel resection and primary anastomosis plus Hartmann's procedure. Postoperatively, eleven patients (52.4%) developed septic shock, while 62% required blood transfusion. There was one (4.8%) early postoperative mortality. Conclusion: To avoid mortality, the diagnosis of ileo-sigmoid knotting should be entertained and the imperative of emergency surgery recognised in the young male or pregnant female patient with acute nocturnal onset abdominal pain, a rapidly deteriorating small bowel obstruction clinical picture and with radiological features suggestive of both small and large bowel obstruction. |
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MeSH term(s) | Adolescent ; Adult ; Aged ; Colon, Sigmoid/surgery ; Gangrene/diagnosis ; Gangrene/mortality ; Gangrene/surgery ; Humans ; Ileal Diseases/diagnosis ; Ileal Diseases/mortality ; Ileal Diseases/surgery ; Ileum/surgery ; Intestinal Obstruction/diagnosis ; Intestinal Obstruction/mortality ; Intestinal Obstruction/surgery ; Middle Aged ; Retrospective Studies ; Sigmoid Diseases/diagnosis ; Sigmoid Diseases/mortality ; Sigmoid Diseases/surgery ; Young Adult |
Language | English |
Publishing date | 2020-07-08 |
Publishing country | South Africa |
Document type | Journal Article |
ZDB-ID | 416504-4 |
ISSN | 2078-5151 ; 0038-2361 |
ISSN (online) | 2078-5151 |
ISSN | 0038-2361 |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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