Damage Control Surgery for Ileosigmoid Knotting With Massive Bowel Necrosis: A Case Report.

INTRODUCTION

Ileosigmoid knotting (ISK) is a rare, life-threatening form of closed-loop bowel obstruction predominantly reported in volvulus-endemic regions, characterized by rapid progression to gangrene and high mortality. This report details a severe case managed with a specialized two-stage approach.

CASE PRESENTATION: A 62-year-old man presented with a 36-hour history of severe crampy abdominal pain, bilious vomiting, and obstipation. Physical examination revealed a distended, tender abdomen, with vitals demonstrating shock. Laboratory results showed a left shift on the complete blood count. Abdominal X-ray suggested obstruction.

MANAGEMENT AND OUTCOME: Emergent exploratory damage control laparotomy revealed gangrene of the sigmoid colon and nearly the entire small bowel, sparing only 70 cm of the proximal jejunum and 10 cm of the distal ileum. Rapid resection without immediate restoration of continuity was completed within 30 minutes due to intraoperative shock. Temporary abdominal closure was achieved using a Bogota bag. Definitive care with jejunoileal end-to-end anastomosis and an end colostomy was completed in a second-look procedure 12 hours later, after adequate resuscitation. The patient was successfully transferred to an intensive care unit for specialized care.

CONCLUSION

This case underscores the utility of damage control surgery in managing complicated compound volvulus with hemodynamic instability and massive necrosis. Early clinical awareness is essential to prevent extensive gangrene, reduce mortality, and optimize survival in resource-constrained settings.