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Ileosigmoid knotting, also known as compound or double volvulus is a rare cause of intestinal obstruction. In this condition the ileum wraps around the base of the sigmoid colon and forms a knot. The condition is serious , generally progressing rapidly to gangrene. Awareness of the condition is essential for prompt diagnosis and optimal management. This report describes a case of 45year old male presented with features of intestinal obstruction and was taken up for emergency laparotomy which revealed ileo sigmoid knotting. Clinical features and management of this rare condition are discussed with relevant review of literature. Key words Ileo sigmoid, knotting, volvulus, intestinal ,obstruction .Ileosigmoid knotting is a rare cause of intestinal obstruction that rapidly progresses to gangrene of the ileum as well as the sigmoid colon. Preoperative diagnosis is difficult because of its  infrequency and atypical radiographic findings. It is essential to differentiate it from sigmoid volvulus because endoscopic reduction is contraindicated in Ileosigmoid knotting. In recent years , CT has been helpful in making the preoperative  diagnosis. Generalized peritonitis and sepsis are the main causes for poor outcome. After hemodynamic stabilization, immediate surgical intervention is needed.


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