Anatomical Variations in Ileo-Sigmoid Knot: Our Experience at Iyi-Enu Hospital (A Suburban Hospital near Onitsha, Anambra State) Nigeria - Case Report

Abstract

Five patients presented or referred with acute intestinal obstruction caused by Ileo-sigmoid knot at lyi-Enu Hospital Ogidi, a suburban hospital near Onitsha, Anambra State, Nigeria between October 1997 and June 2002 are described. All were blacks of Ibo tribe of South East Nigeria in the West African sub-region indicating that this condition can also be seen in blacks of West Africa as well. Existence of the disease he been reported extensively in blacks of Southern and East Africa, in many series; (Kallio 1932, Faltin 1938, Burkit 1960 and Hall-Craggs 1960). The incidence of the disease may be the same in all three regions (West, East, and Southern Africa). Owing to its complex nature correct pre-operative diagnosis was only made in one patient who had a typical radiological appearance of ileo-sigmoid knotting (Compound Volvulus). Three of the patients were referred to us, one after gridiron incisional exposure for appendectomy, one after lower midline vertical laparotomy exposure for supposed small bowel obstruction from adhesion, the third after upper midline vertical laparotomy exposure for supposed perforated duodenal ulcer with peritonitis. On the fifth patient correct pre-operative diagnosis was not made before operation. The possible etiologies, anatomical variations and operative techniques are discussed; as well as the inherent problems in further management of the referred patients by doctors inexperienced in dealing with complex surgical entity ab inito.