Ileosigmoid Knotting: Case Report of a Rare Knot

Ileosigmoid knotting (ISK) is a rare, life-threatening condition often difficult to diagnose radiologically. We report a 55-year-old male presenting with acute abdominal pain. While CECT suggested a closed-loop obstruction, exploratory laparotomy revealed ISK with gangrenous ileum, requiring resection and loop ileostomy. Because ISK carries high mortality, this case emphasizes the importance of maintaining a high index of suspicion when imaging indicates closed-loop obstruction. Early resuscitation and immediate surgical intervention are critical for successful management.