Dereje WM, Zegeye ML, Wulolgn D, Tamene BA, Kassie MT. Ileosigmoid knotting causing gangrenous bowel obstruction in a postpartal mother presented with septic shock: A case report and review of literature. World J Obstet Gynecol 2026; 15(2): 118869 [DOI: 10.5317/wjog.118869]
Corresponding Author of This Article
Wondwosen Mengist Dereje, MD, Department of Neurology, University of Gondar, Maraki Street, Gondar 196, Ethiopia. wondwosenmengist4@gmail.com
Research Domain of This Article
Surgery
Article-Type of This Article
case-report
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Dereje WM, Zegeye ML, Wulolgn D, Tamene BA, Kassie MT. Ileosigmoid knotting causing gangrenous bowel obstruction in a postpartal mother presented with septic shock: A case report and review of literature. World J Obstet Gynecol 2026; 15(2): 118869 [DOI: 10.5317/wjog.118869]
Wondwosen Mengist Dereje, Department of Neurology, University of Gondar, Gondar 196, Ethiopia
Melkamu Lake Zegeye, Dawit Wulolgn, Melaku Tessema Kassie, Department of Surgery, University of Gondar, Gondar 196, Ethiopia
Bahran Afework Tamene, Department of Gynecology and Obstetrics, University of Gondar, Gondar 196, Ethiopia
Author contributions: Dereje WM contributed to data analysis, conceptualization and supervision; Kassie MT contributed to supervision; Dereje WM, Zegeye ML, Wulolgn D, Tamene BA, and Kassie MT contributed to manuscript writing and editing, data collection.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Wondwosen Mengist Dereje, MD, Department of Neurology, University of Gondar, Maraki Street, Gondar 196, Ethiopia. wondwosenmengist4@gmail.com
Received: January 13, 2026 Revised: February 14, 2026 Accepted: March 16, 2026 Published online: September 8, 2026 Processing time: 232 Days and 11.8 Hours
Abstract
BACKGROUND
Ileosigmoid knotting, also referred to as compound volvulus, is a rare but potentially fatal cause of bowel obstruction. Only a limited number of cases have been reported since its first description. Prompt recognition and urgent surgical management are essential, as delayed diagnosis can lead to bowel gangrene, sepsis, and significant morbidity or mortality.
CASE SUMMARY
We report a 30-year-old para V lactating mother on her third postpartum day following an uneventful vaginal delivery. She presented with a three-day history of failure to pass feces and flatus, initially vomiting ingested matter that later became bilious, along with progressive abdominal distension. Her symptoms were preceded by initially mild, nonlocalized, crampy abdominal pain that gradually worsened over time. On admission, she was in shock, with unrecordable blood pressure and absent peripheral pulses. After insertion of two large-bore intravenous cannulas and aggressive fluid resuscitation, her hemodynamic status improved. Plain abdominal radiography suggested bowel obstruction. Emergency laparotomy revealed the sigmoid colon entrapped by the ileum. En bloc resection with rectal anastomosis and end ileostomy was performed. Relevant literature was reviewed to assess the diagnosis, management, and prognosis of ileosigmoid knotting.
CONCLUSION
Ileosigmoid knotting is an uncommon yet life-threatening cause of acute intestinal obstruction requiring a high index of suspicion. Rapid progression to bowel gangrene and septic shock necessitates early diagnosis, aggressive resuscitation, and prompt surgical intervention. Surgical management should be guided by bowel viability and hemodynamic stability, with stoma formation serving as a life-saving option in unstable patients. Early intervention and appropriate perioperative care can significantly improve outcomes.
Core Tip: Ileosigmoid knotting is a rare, life-threatening cause of intestinal obstruction, often presenting with nonspecific symptoms such as abdominal pain, distension, and vomiting. Diagnosis is challenging due to overlapping imaging features with sigmoid volvulus, and preoperative recognition is uncommon. Prompt aggressive resuscitation, correction of electrolyte and acid-base disturbances, and timely laparotomy are crucial. Surgical management depends on bowel viability, ranging from untwisting to en bloc resection with stoma formation. Early intervention, perioperative care, and close follow-up can significantly improve outcomes, even in patients presenting with shock and extensive bowel gangrene.
