The diagnostic efficiency of CT and MRI in ileosigmoid knotting

in all patients because of the poor condition of some patients or nonavailability, whenever possible, they may be useful in making an ISK diagnosis by demonstrating a whirl sign created by the twisted ileum and sigmoid colon mesenteries in addition to the dilated sigmoid colon with loss of haustral pattern and dilated ileum loops (1–8). In addition to the whirl sign on CT, Mandal et al. (2), Tamura et al. (4), and Lee et al. (5) reported a medial translocation of the cecum and left colon; Hirano et al. (6) and Hashimoto et al. (7) reported a radial distribution of the bowel and mesenteric vessels; Hirano et al. (6) reported the convergence of stretched and elongated superior and inferior mesenteric vascular structures toward the whirl; and Baheti et al. (8) reported the appearance of a beak in the afferent and effernet limbs of the sigmoid colon. In our opinion, the presence of the whirled ileum and sigmoid mesenteries in the knot in addition to the dilated sigmoid colon and intestinal air-fluid levels on abdominal CT or MRI is highly diagnostic in ISK, and the use these advanced techniques may be useful when this rare clinical entity is suspected, in addition to the preferable use of MRI in pregnant patients (9,10)