Acute small bowel obstruction as a result of an appendicular knot encircling the terminal ileum: an exceptionally rare case report

Abstract

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.

Role of Multidetector Computed Tomography with Multiplanar and Curved Multiplanar Reformations in the Detection of Cause of Intestinal Obstruction: A Tertiary Care Experience

“…It was diagnosed as inverted Meckel's diverticulum and the diagnosis was confirmed on surgery ( Figure 1). Few case reports have been published that report an inverted Meckel's diverticulum as the cause of small bowel obstruction [14][15]. Colorectal carcinoma, volvulus, and diverticulitis account for approximately 80%-85% of all large bowel obstructions.…”

Appendico ilial knotting: a rare cause of small bowel obstruction

“…Strangulation can be due to the appendix wrapping around the base of a bowel loop, or when inflamed appendix adheres to caecum, small intestine or posterior peritoneum and a part of the bowel herniates through the gap. This is described with appendicular KNOT, appendicular tourniquet, appendiceal tie syndrome and appendico-ilial knotting [ 6 , 7 , 9 , 10 ]. in our opinion, appendico-ilial knotting is the preferred name because it describes the pathologies of both appendix and ilium.…”

Acute intestinal obstruction due to appendicular tie syndrome: a rare case report

“…The tip of a long appendix is usually found adherent to cecum, retroperitoneum, mesentery of ileum, forming a potential space where a loop of bowel may entrap. 1 Acute inflammation of the appendix is probably the initiating event of this band formation.…”

“…The reported complications of appendicular tie syndrome are intestinal obstruction, volvulus, strangulation of the small bowel, and strangulation of appendix itself. 1 In 2009, Bhandari et al classified intestinal obstruction because of appendicitis into four types: adynamic, mechanical, strangulation, and caused by mesenteric ischemia. 4 Adynamic obstruction or paralytic ileus is the most common type and it is due to the appendicular inflammation spreading to the surrounding structures (caecum, small bowel or posterior peritoneum).…”

“…As appendicitis can cause mechanical small bowel obstruction because of adhesion. 1 But, there are very few cases of mechanical small bowel obstruction developed as a direct result of appendicitis have been reported in literature. Hotchkiss first reported in 1904, but till today, there are only few cases have been reported.…”