A Rare Case of Life-Threatening Gangrenous Ileosigmoid Knotting: Successful Primary Anastomosis Without Stoma in a Carefully Selected Patient.

Ileosigmoid knotting (ISK) is a rare, rapidly progressive cause of intestinal obstruction that frequently results in bowel ischemia, gangrene, and high mortality if not treated promptly. In patients with gangrenous ISK, surgical management has traditionally favored bowel resection with stoma formation because of concerns regarding anastomotic failure. We report the case of a 60-year-old man who presented with acute intestinal obstruction and generalized peritonitis after six days of progressive symptoms. Following prompt resuscitation, emergency exploratory laparotomy revealed gangrenous ileosigmoid knotting involving approximately 60 cm of the distal ileum and the sigmoid colon. Resection of the nonviable bowel was performed, followed by primary ileo-ileal and colo-colic anastomoses without a diverting stoma because the bowel ends were well perfused, suitable for primary anastomosis, and there was no gross fecal contamination. The postoperative course was uneventful, with restoration of bowel function by postoperative day 2, and the patient was discharged on postoperative day 9 with satisfactory recovery. This case demonstrates that primary anastomosis without a diverting stoma may be a safe and feasible option in carefully selected patients with gangrenous ISK when favorable intraoperative conditions are present. It underscores the importance of early resuscitation, meticulous intraoperative assessment, and individualized surgical decision-making rather than a uniform approach to stoma formation.