Appendicitis as a cause of intestinal strangulation: a case report and review

Abstract

Intestinal obstruction is a common surgical emergency caused by varied conditions. Appendicitis as a cause is both uncommon and unsuspected. Strangulation of intestine caused by appendicitis is extremely rare with very few cases reported in literature. The diagnosis of such a condition is possible only on table, with CT having questionable value. This is a very rare and dangerous complication of a very common disease which can easily be overlooked. Every emergency surgeon needs to be aware of such a possibility.We report a case of a 24 year old male presenting with classical features of intestinal obstruction. On laparotomy strangulated bowel was seen and appendix was found to be the cause. Although we obtained a history of appendicitis in this patient, it was not correlated to the present condition due to the rarity of such a scenario. We reviewed literature to find similar cases reported in the past.

Figure 1

On table picture showing dilated proximal intestinal loops and a part of Ischemic ileum. Note the clear line of demarcation between healthy and involved ileum.

Figure 2

Higher magnification picture showing the band which had produced strangulation. This band composed predominantly of appendix and in part by omentum (not shown in this picture). Note the area of attachment of the band on distal ileum.

Figure 3

Diagrammatic representation of the process of intestinal strangulation. Appendix adhered to distal ileum producing a window underneath. Part of bowel herniated through the gap and underwent strangulation.