Comments on ‘The Role of Ramadan Fasting on Intestinal Volvulus and Knotting’

We read the article written by Hafidh at al[1] on the effects of Ramadan fasting on human health. Among the discussed subjects, our comments relate to the effects of fasting on sigmoid volvulus (SV) and ileosigmoid knotting (ISK) based on our 57-year (from June 1966 to July 2023) experience including 1,071 SV patients, the most comprehensive monocenter SV data over the world, and 80 ISK cases, one of the most extensive worldwide ISK series.[2]

SV, rotation of the sigmoid colon around itself causing a colonic obstruction, is a rare disease. Similarly, ISK, twisting of the ileum or sigmoid colon around each other, resulting in a double-loop intestinal obstruction, is a very rare clinical entity. Most likely due to the rarity of these conditions, the relationship between fasting and SV or ISK is not clearly defined.[3] Of 416 SV patients evaluated in our series, 31 (7.5%) are caused by fasting, while 8 of 80 ISK patients (10.0%) are caused by fasting. In these cases, fasting looks likely to lead to the development of both SV and ISK when compared with nonvolvulus intestinal obstructions (7.5 vs. 2.0% and 10.0 vs. 1.3%, respectively, p < 0.05, chi-squared test). In theoretical opinion, ingestion of high-bulk food and fluid after prolonged fasting may cause rapid transportation of intestinal content into small and large bowels and may force them into rotation or knotting.[4] [5] Although this theory needs additional evidence including prospective data analyses of large SV and ISK series, the rarity of both diseases makes it difficult at least for now or in the near future.

Conflict of Interest

The authors declare that they have no conflict of interest.

Authors' Contribution

All the authors contributed equally to the study.

Compliance with Ethical Principles

Ethical approval not required.

• References

• 1 Hafidh K, Khan M, Shaikh GT. et al. Review of the literature on Ramadan fasting and health in 2022. Ibnosina J Med Biomed Sci 2023; 15 (42) 50-66
• 2 Atamanalp SS, Peksöz R, Dişçi E. Sigmoid volvulus and ileosigmoid knotting: An update. Eurasian J Med 2022; 54 (suppl 1): 91-96
• 3 Web of Science. . Sigmoid volvulus and ileosigmoid knot. Accessed July 25, 2023 at: https://www.webofscience.com/wos/woscc/summary/9b4d06ef-8abb-4e17-a00b-5985907a6fd8-99ace658/relevance/1
• 4 Dişçi E, Atamanalp SS. Factors precipitating volvulus formation in sigmoid volvulus. Ulus Travma Acil Cerrahi Derg 2022; 28 (03) 281-284
• 5 Korkut E, Atamanalp SS. Factors triggering knot formation in ileosigmoid knotting. Pak J Med Sci 2022; 38 (06) 1714-1716

Publication History

Article published online:
29 August 2023