TPT 3.06 A Rare Surgical Catastrophe: Systematic Review of Clinical Characteristics and Outcomes in Ileo-Ileal Knotting

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ID: 324067
2026
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Abstract
Abstract Background Ileo-ileal knotting (IIK) is a rare and catastrophic subset of mechanical small bowel obstruction characterised by the ileum forming a tight, self-constricting knot. Due to scarcity, clinical guidelines regarding preoperative diagnosis and operative decision-making, specifically the safety of detorsion versus resection, remain undefined. This systematic review aims to aggregate global data to delineate the clinical characteristics, diagnostic challenges, and optimal surgical management of IIK. Methods This systematic review adhered to PRISMA guidelines. MEDLINE, Embase, and Pubmed were searched from inception to January 2025. Inclusion criteria comprised case reports and series with a confirmed intraoperative diagnosis of IIK. Demographics, imaging findings, degree of ischemia, and surgical interventions were extracted and analysed descriptively. Results Forty-five studies representing 49 patients were included (Mean age: 40 years; Range: 11 months - 90 years), with an even gender distribution. The condition exhibited geographical clustering in Ethiopia, India, and Japan. Gangrene of the knotted segment was present in 85.7% of cases, a rate significantly higher than other forms of obstruction. Preoperative imaging frequently failed; plain radiography was non-diagnostic, and CT often mimicked simple volvulus. Definitive diagnosis was invariably intraoperative. En-bloc bowel resection was required in 85.7% of cases due to extensive necrosis. Mortality was 4.1%. Conclusions Ileo-ileal knotting acts as a "double-loop" obstruction associated with rapid mesenteric ischemia and a high rate of gangrene. Diagnostic ambiguity is common, necessitating a high index of suspicion. Given that over 85% of cases present with necrosis, en-bloc resection without untying may be recommended to prevent perforation and reperfusion injury.
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Authors Abir Mamun, Yumna Saleem, Yahya El-Tahlawy, Ruhan Ullah, Norman Mohan
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag087.189
URL
https://doi.org/10.1093/bjs/znag087.189
Keywords Keywords not found

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