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In the developed world, small bowel obstruction accounts for 20% of all acute surgical admissions. The etiology for majority of these cases includes postoperative adhesions and hernia. However, appendicular knot is exceptionally rare. We report a case of a 65-year-old patient presented to the emergency room with complaint of abdominal pain, distension of abdomen, vomiting, and absolute constipation for 4 days. All the routine hematological and radiological investigations were carried out; the patient underwent laparotomy and was diagnosed with small bowel obstruction due to appendicular knot encircling the terminal ileum.

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Adverse drug reactions to the prescribed medicines are the major obstacles in continuation of drug treatment. Nimesulide, a selective cyclo-oxygenase (COX-2) inhibitor was first launched in Italy in 1985 and subsequently marketed in more than 50 countries including India. Due to its better and faster antipyretic action, it has gained popularity among physicians and paediatricians. Here, we report a case of 60 years old male patient who developed toxic epidermal necrolysis (TEN) following ingestion of tablet nimesulide. The patient was managed with parenteral corticosteroids, antibiotics, emollients, anti-fungal and supportive care. This case highlights the importance of nimesulide and other NSAIDs as possible cause of TEN. Nimesulide has never been approved in countries like USA, Canada, Britain, New Zealand, Australia. But in India it is available as over the counter drug and is used for various indications like fever, myalgia, arthralgia. Therefore, the drugs which are banned outside India should be used with caution and medical practitioners should report all the adverse drug reactions to such drugs.