В Эфиопии у пяти пациентов обнаружили опасную редкую патологию — кишечный узел, перекрывший кровоток

Rare "Knot" That Was Cutting Blood Flow Found in a Patient's Intestines Five patients treated at a hospital in Ethiopia were found to have twisted bowel, a rare form of intestinal obstruction in which the ileum and sigmoid colon become twisted together. The condition is called ileosigmoid knotting, and although it is uncommon, it can become dangerous quickly. The twisting can trap two sections of bowel at once, cutting off circulation and causing the affected tissue to die. In a recently published review of cases from the said hospital in Ethiopia, doctors reported that four out of five patients had gangrenous sections of both the ileum and sigmoid colon. Nevertheless, all five underwent surgery and recovered without requiring a stoma. A Rare Cause of Intestinal Obstruction Ileosigmoid knotting occurs when the ileum, the last part of the small intestine, wraps around the sigmoid colon, a section of the large intestine. The resulting knot can create a closed-loop obstruction, preventing intestinal contents from moving normally. At the same time, the twist can compress blood vessels in the bowel. That combination makes the condition particularly dangerous. As circulation becomes impaired, the affected intestine can become ischemic. If the blood supply is not restored, the tissue may eventually become necrotic and gangrenous. The Problem May Not Be Obvious at First Patients with ileosigmoid knotting can initially appear to have a more typical intestinal obstruction. Symptoms may include abdominal pain, vomiting, abdominal swelling, and an inability to pass stool or gas. Because the condition is so uncommon, recognizing it before surgery can be difficult. Imaging may show signs of obstruction or twisting, but the exact cause is not always apparent. In the Ethiopian case series, all five cases were ultimately diagnosed during surgery. The patients had presented with abdominal pain, while some also had vomiting, abdominal distension, peritonitis, or signs of shock. Surgeons Found the Intestine Twisted Into a Knot The diagnosis became clear when the surgeons opened the abdomen. An ileal loop had twisted around the sigmoid colon, creating the characteristic ileosigmoid knot. In four of the five patients, the twisting had already caused gangrene involving the ileum and sigmoid colon. Gangrene in this setting means that part of the bowel tissue had died after losing its blood supply. The affected sections had to be removed. The surgeons then reconnected the remaining bowel rather than creating a stoma. According to the case series, all five patients were discharged with improvement, with no deaths recorded during their hospital stay. Why the "Knot" Is So Dangerous The intestine depends on a steady blood supply to keep its tissue alive. When the bowel twists tightly, blood vessels within and around the affected segments can become compressed. The obstruction also causes the trapped bowel to swell, which can further compromise circulation. The result can be a rapid progression from obstruction to ischemia and then gangrene. If the dead bowel is not removed, the intestinal wall can eventually perforate. That can allow bowel contents to spill into the abdominal cavity and trigger a severe infection. This is why ileosigmoid knotting is treated as a surgical emergency rather than a condition that can simply be observed. Not Every Patient Needs a Stoma When surgeons remove damaged intestines, they must decide how to restore the digestive tract. One option is to reconnect the healthy ends of the bowel immediately. Another is to create a stoma, an opening through the abdominal wall through which intestinal waste can pass into a pouch. The choice depends on factors such as the patient's condition, the extent of bowel damage, inflammation, and whether the remaining bowel is healthy enough to be safely joined. In the recently reported series, surgeons performed primary anastomosis after removing the gangrenous bowel, and none of the five patients required a stoma. That outcome is notable because gangrenous bowel can make reconstruction more complicated and, in some patients, diversion with a stoma may be considered safer. A Rare Condition That Can Progress Quickly Ileosigmoid knotting remains an unusual cause of intestinal obstruction. It is particularly challenging because doctors may have to recognize both the obstruction and the loss of blood supply before irreversible damage occurs. The condition is also not something most people would associate with ordinary abdominal pain. Still, severe or persistent abdominal pain, repeated vomiting, marked abdominal swelling or an inability to pass stool or gas can indicate an intestinal obstruction and warrants prompt medical attention. For the patients in the recent case series, what initially presented as an acute abdominal emergency turned out to have an unusual cause: two sections of intestine had become entangled in a dangerous knot. Once the blood supply was compromised, there was little room for delay. Surgery was needed to remove the damaged bowel and restore the continuity of the digestive tract. Published by Medicaldaily.com