Ileosigmoid Knotting : A Report of Two Cases

Background: Ileosigmoid knotting (ISK) is a rare cause of acute intestinal obstruction with high morbidity and mortality. The diagnosis is rarely made preoperatively because of its infrequency and the variations in presentation.Aim: To report two cases managed by the author; which will hopefully increase awareness of this condition.Case Reports: The first was a 51-year-old man who presented with a sudden onset of colicky lower abdominal pain; which later became generalized. His pulse rate was 100 beats/minute while his blood pressure was 80/60 mmHg.There was mild abdominal distension with absent bowel sounds. The second was a 50-year-old man with a sudden onset of generalized colicky abdominal pain; abdominal distension and vomiting. His pulse rate was 120 beats/minute and the blood pressure 80/50 mmHg. His bowel sounds were markedly reduced. They were resuscitated accordingly. In both patients; exploratory laparotomy revealed a copious amount of sero-sanguinous fluid in the peritoneal cavity with ileosigmoid knotting; and extensive gangrene involving the distal ileum and the sigmoid colon. In the first patient; the caecum was involved in the knot and therefore also gangrenous. Each of them had a sigmoid colectomy with a right hemicocetomy. The first patient died of adult respiratory distress syndrome while the other had an uneventful recovery. In the patient who died; surgery was done on the third day of onset of symptoms.Conclusion: A high index of suspicion; aggressive resuscitation; and prompt surgical intervention are indispensable for a successful outcome

Familial polyposis in two Ethiopians

Cases of familial polyposis coli and Peutz-Jeghers syndrome are reported for the first time in Ethiopia. One case seemed to have the defect as a new mutation in his gene while the other possibly inherited from his father. The one with polyposis coli had transmitted the disease to his offspring. This patient had total colectomy for prophylaxis against a potential carcinoma of colon

Colectomie sans preparation avec anastomose immediate

Devant les inconvenients que presente la chirurgie colique en plusieurs temps avec presence d'une colectomie; et vu que quelques cas d'anastomoses coliques non protegees pratiquees en urgence ont ete rapportes; les auteurs se sont decides a partir de 1984 d'appliquer cette nouvelle approche therapeutique. Entre 1984 et 1990; ils ont pratique en urgence 43 colectomies avec anastomoses immediates non protegees par une colostomie d'amont; pour diverses raisons: volvus du sigmoide dans 79;3 pour cent des cas; tumeur du caecum dans 7 pour cent des cas et autres. Les resultats sont excellents car les auteurs n'ont observe aucun cas de de desunion anastomotique et n'ont deplore aucun cas de deces. En outre; la duree moyenne d'hospitalisation a ete de 12;3 jours. Fort de ces resultats on peut aujourd'hui affirmer que la preparation intestinale n'est pas indispensable pour la chirurgie colique. D'autre part; devant les espoirs de superiorite suscites par la suture mecanique; on peut affirmer que la suture manuelle demeure valable pourvu que son execution respecte quelques precautions elementaires