Laparoscopic management of an unusual case of small bowel obstruction: appendiculoileal knotting

Abstract

Appendicitis presenting at small bowel obstruction due to the formation of encircling loop around a bowel segment is a rare occurrence. We report such case managed with the laparoscopic approach. A 45-year-old woman presented to emergency services with severe pain in abdomen and bilious vomiting in the past 2 days, having a history of abdominal hysterectomy 10 years ago. The abdominal examination was suggestive of bowel obstruction. A CT showed dilated bowel loops with complete cut-off at the level of the terminal ileum. The patient was taken for diagnostic laparoscopy. The inspection of the small bowel revealed an appendicular looping around the small bowel lumen. After separating, the appendix obstruction was relieved. Then, the tip of the appendix was dissected free from the parietal wall along with approximately 5 mL purulent fluid. Appendectomy was completed and based looped doubly using catgut endoloop. The patient had an uneventful recovery and was discharged on the second postoperative day.