Abstract
Small bowel obstruction due to ileo-ileal knotting is rare. Ileo-ileal knotting usually presents with clinical features of small bowel obstruction with rapid deterioration to bowel necrosis, and the management includes prompt surgical intervention. Here, we present a case of a 35-year-old patient who presented to our emergency room with severe non-radiating crampy abdominal pain for 18 hours. The patient underwent an emergency laparotomy as an intervention. Ileo-ileal knotting preoperative diagnosis is challenging due to its nonspecific presentation, the diagnosis is usually done intraoperatively, and the overall management of gangrenous ileo-ileal knotting is urgent laparotomy and en bloc resection of the gangrenous ileo-ileal knotting and anastomosis of the remaining viable bowel. If the bowel is viable, careful untying of the loops usually suffices. Ileo-ileal knotting should be considered in patients presenting with features of small bowel obstruction having rapid deterioration with signs of gangrenous bowel, and it requires urgent surgical intervention after adequate resuscitation.