article · BMC Surgery
This systematic review and meta-analysis investigated ileosigmoid knotting (ISK), a rare but severe form of intestinal obstruction, specifically within Sub-Saharan Africa. The study analysed data from ten observational studies involving 349 patients across six countries between 1949 and 2025. It found that ISK predominantly affects young-to-middle-aged rural men, with abdominal distension being a near-universal symptom and shock present in over a quarter of cases. Bowel gangrene was observed in the majority of patients (68%). While in-hospital mortality was 20% overall, it has significantly decreased from 50% before 2000 to 11% since 2015. The research highlights the need for aggressive shock reversal, individualised surgical decisions, and standardised reporting to further improve outcomes.
Ileosigmoid knotting is a life-threatening intestinal condition with high mortality, particularly in Sub-Saharan Africa. This research provides crucial insights into its regional epidemiology, patient characteristics, and treatment outcomes. Understanding these trends can help healthcare providers improve early diagnosis, surgical management, and post-operative care, ultimately saving lives and reducing the burden of this severe disease.
The abstract does not indicate an application pathway for commercialisation. It identifies priorities for clinical practice improvement, such as aggressive shock reversal, individualised intraoperative decision-making, and standardised reporting, which are relevant for medical training and healthcare policy rather than direct commercial products or services.
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Abstract Background Ileosigmoid knotting (ISK) is a rare double-segment closed-loop intestinal obstruction in which the ileum and sigmoid colon entwine, frequently progressing to bowel gangrene within hours. Although rare worldwide, it is concentrated within the volvulus belt of which Sub-Saharan Africa (SSA) is a major component. No prior synthesis has quantitatively pooled the regional epidemiology, surgical management and outcomes. Methods We performed a PRISMA-2020-compliant systematic review and meta-analysis. PubMed, Scopus, Web of Science, AJOL and Google Scholar were searched from inception to January 2026. Original observational studies (≥ 5 patients) from any SSA country were eligible. Then it independently screened, extracted and appraised (adapted Newcastle–Ottawa Scale). Random-effects DerSimonian–Laird pooled proportions were generated, with subgroup, meta-regression and Egger analyses. Results Ten studies (349 patients from six countries) met inclusion criteria (1949–2025). The pooled cohort was 79.1% male, mean age 42.9 years. Abdominal distension was near-universal (85%, I² = 0%); shock at presentation was 27% (95% CI 17–37%). Both segments were gangrenous in 68% (95% CI 54–82%) and only 12% had two viable segments. Resection with primary anastomosis was performed in 53% and Hartmann’s procedure in 39%. Pooled in-hospital mortality was 20% (95% CI 8–32%; I² = 90.2%), falling from 50% pre-2000 to 11% since 2015 ( p < 0.001); meta-regression confirmed a per-year decline (β = −0.035, p = 0.024, R² = 70%). Pooled anastomotic leak was 6% (I² = 13.7%). Conclusion ISK in SSA affects young-to-middle-aged rural men, with bowel gangrene present in the majority of cases. Contemporary mortality has fallen five-fold to 11% but remains unacceptable. Aggressive shock reversal, individualised intraoperative decision-making and standardised reporting are priorities.
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DOI: 10.1186/s12893-026-04129-y
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