Ileoileal knotting a rare cause of double loop small bowel obstruction, diagnostic and intraoperative challenge at Ethiopian Leku district hospital,sidama region, April 2023 ,case report

Abstract

Abstract Baground: Intestinal obstruction is common cause for abdominal surgeries. Among the causes for intestinal obstruction ileal knotting is the unusual and rare cause with very few case reports in the globe and in Ethiopia. Almost all cases were intraoperative surprises. We report a case of strangulated closed small bowel loop obstruction caused by ileoileal knotting at distal ileum near to ileocecal junction, its diagnostic and management challenges and the role of the “Integrated Emergency surgical officers(IESO)’’ for early emergency surgical interventions in district primary hospitals in Ethiopia where there is scarce general specialist surgeon. Case presentation: Here we discuss a 78yrs old male Ethiopian patient presented to our district hospital with sign symptoms of strangulated small bowel obstruction and exploratory laparatomy was done with intraoperative surprise of ileoileal knot with gangrenous closed loop obstruction at ileocecal junction. The gangrenous segment was resected and ileo-ascending colon anastomosis was done.The post operative stay was uneventful and patient discharged on his 7th post operation date. Conclusion: Here we present this case to highlight difficulty of preoperative diagnosis and the need of high index of suspicion as well as the management challenges of resection anastomosis when the knot is near to ileocecal junction and the undeniable role of emergency surgical officers for early interventions of such emergency cases who need early interventions.