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

We read the article written by Ha fi dh 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 mono-center 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 de fi ned. 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 fl uid 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