Acute appendicitis presenting as small bowel obstruction: two case reports

Abstract

Acute appendicitis is a common surgical problem however the diagnosis is often overlooked when it presents as a small bowel obstruction. In this report we present two cases of elderly patients who presented with small bowel obstruction and raised inflammatory markers. Both patients were successfully treated with a laparotomy, adhesiolysis and appendicectomy and went on to make a good recovery.

Intestinal Obstruction due to Acute Appendicitis

“…However, the role of CT in detecting appendicitis is also case-by-case; often, it is not found due to the inflamed appendix being wrapped around the ileum [11][12][13]15]. It may be seen in enlarged purulent appendicitis [3], as in our case. Thus, CT's ability to diagnose appendicitis is related to the progression of the inflamed appendix.…”

“…5c) [11]. These three forms can all cause intestinal obstruction due to tightening, folding, twisting, pinching, or pulling of the appendicitis [3]. With closed loop obstruction, the inflamed appendix wraps around the last loop of the ileum (Fig.…”

“…Acute appendicitis is the most common abdominal emergency in both adults and children [1], and has been proven to be a usual cause of small bowel obstruction (SBO) [2]. This condition usually occurs as an effect of adhesion because of periappendicular inflammation [3]. On the other hand, acute appendicitis may rarely present as SBO [4].…”

“…Since then, individual cases have been reported in the literature, but very few systematic reviews have been found on this subject [ 7 , 8 ]. In case of co-existence of the two diseases, the clinical presentation of SBO might predominate the clinical features and hide the usual symptoms of appendicitis [ 3 ]. Abdominal imaging has an important role in the diagnosis of acute appendicitis as well as SBO, revealing whether intestinal obstruction occurs, where it is located, how severe the obstruction is, and what its cause is.…”

Diagnostic Challenges in Acute Appendicitis

“…Another unusual presentation of acute appendicitis is as a small bowel obstruction with raised inflammatory markers. Harrison et al (2009) describe two elderly patients presenting with small bowel obstruction diagnosed on computed tomography scans to be due to an acute appendicitis (Figure 3). Often the inflammatory process that accompanies acute appendicitis can result in small bowel obstruction.…”