Appendiceal tie syndrome: A very rare complication of a common disease

Abstract

Acute appendicitis is the most common surgical emergency that we encounter. Adynamic Intestinal obstruction due to appendicitis or its complication may be seen time and often. Mechanical obstruction because of appendicitis is uncommon and even rarer for a closed loop obstruction to occur. Although it was described as early as 1901, very few cases have been reported. We report the case of a 20 years male who presented with generalized colicky pain abdomen, abdominal distension, vomiting and obstipation for three to four days. Vital signs were stable. His abdomen was distended and peritonitic, especially in the right iliac fossa. Rest of the physical examination was unremarkable. Blood tests were normal except for leucocytosis with neutrophilia. An abdominal X-ray finding was indicating a small bowel obstruction. A midline laparotomy was performed. On intraoperative examination, distended loops of small bowel from the jejunum to the distal ileum was observed, and a constricting ring around the terminal ileum created by a phlegmonous appendicitis with its tip adherent to the root of mesentery was found, obstructing an edematous loop of small bowel without signs of ischemia. As the bowel was viable simple appendectomy was done. Postoperatively, he had an uneventful recovery and was discharged after 3 d.

Keywords: Appendicitis, Appendicular band, Intestinal obstruction, Mechanical small bowel obstruction, Closed loop obstruction

Core tip: It is safe to say, almost no-one will become a surgeon without seeing or doing appendectomy. It is so common, yet time and often we are deceived by it. As we know, abdomen is a “Pandora’s box”, we never know what come up sometimes and this is a perfect example. We report a case of mechanical small bowel obstruction due to acute appendicitis that was timely and successfully managed surgically.