Gastrointestinal surgery: ileosigmoid knotting: practice question

A General Surgery question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Surgery · Gastrointestinal surgery: ileosigmoid knotting

Sample item

A young farmer breaks a long fast with a heavy meal and within hours has severe colicky abdominal pain, vomiting and rapid distension. Films show dilated small bowel loops together with a dilated sigmoid loop. He becomes toxic within hours. What is the most likely diagnosis?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

B. Ileosigmoid knotting

In ileosigmoid knotting the ileum twists around the sigmoid base, so two segments are obstructed at once and both can become gangrenous quickly. Treatment is urgent laparotomy and resection of nonviable bowel.

Option by option

  • A. Adhesive small bowel obstruction

    Adhesive obstruction needs prior surgery and does not dilate the sigmoid.

  • B. Ileosigmoid knotting (correct)

    Correct. Simultaneous small bowel and sigmoid obstruction with rapid toxicity fits a knot of ileum around sigmoid.

  • C. Primary sigmoid volvulus

    Primary sigmoid volvulus does not obstruct the small bowel and usually progresses more slowly.

  • D. Caecal volvulus

    Caecal volvulus gives a dilated caecum in the left upper abdomen, not a dilated sigmoid.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Ileosigmoid knotting. In ileosigmoid knotting the ileum twists around the sigmoid base, so two segments are obstructed at once and both can become gangrenous quickly.

Why is "Adhesive small bowel obstruction" not the answer?

Adhesive obstruction needs prior surgery and does not dilate the sigmoid.

Why is "Primary sigmoid volvulus" not the answer?

Primary sigmoid volvulus does not obstruct the small bowel and usually progresses more slowly.

Why is "Caecal volvulus" not the answer?

Caecal volvulus gives a dilated caecum in the left upper abdomen, not a dilated sigmoid.

What concept does this question test?

It tests Gastrointestinal surgery: ileosigmoid knotting in General Surgery. Treatment is urgent laparotomy and resection of nonviable bowel.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Gastrointestinal surgery: ileosigmoid knotting?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.