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January 26, 1970

The Intestinal Knot Syndrome

Author Affiliations

Washoe Medical Center Reno, Nev

JAMA. 1970;211(4):662-663. doi:10.1001/jama.1970.03170040066019

To the Editor:—  An interesting, but rare, intestinal obstruction is the "intestinal knot syndrome," occasionally referred to as "double volvulus" or "compound volvulus." The phenomenon begins with a sigmoid volvulus with subsequent wrappings of the ileum about its axis, forming an intestinal knot.1 Due to the devitalization of both knotted segments, the prognosis is grave unless there is early surgical intervention.2,3

History.—  The earliest reported case was that of Parker in 1845, entitled, "Case of Intestinal Obstruction: Sigmoid Flexure Strangulated by the Ileum."4 Kallio's extensive review (1932) reported 161 cases including 77 from Finland.5 Recent reports from Africa reveal, among others, 92 cases in Uganda.6-8The lesion is rare in the United States. In a review of 52 cases of sigmoid volvulus from Grady Hospital, Atlanta, there were two instances of intestinal knotting.1 To date, no precipitating factors have been identified. Frimann-Dahl postulates that