Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Aug 8;13(1):208.
doi: 10.1186/s13256-019-2156-y.

Mechanical small bowel obstruction due to appendiceal tourniquet: a case report and review of literature

Khaled Ahmed Ahmed  1 , Ahmed Mohamed Farid Hamdy  2 , Moustafa Ibrahim Seifeldin  2 , Moustafa Refaie Elkeleny  2
Affiliations
Review

Mechanical small bowel obstruction due to appendiceal tourniquet: a case report and review of literature

Khaled Ahmed Ahmed et al. J Med Case Rep. .

Abstract

Background: Acute appendicitis is known to cause intestinal obstruction. The presentation is commonly due to functional obstruction, but on very rare occasions it presents as mechanical obstruction, especially closed loop.

Case presentation: We report a case of a 59-year-old Egyptian man who presented with symptoms suggestive of intestinal obstruction. On examination, he was afebrile with distended tender abdomen with no obvious hernias. There was no history of previous abdominal surgery. Laboratory investigations were within normal range except for elevated serum creatinine levels. Plain erect X-ray and computed tomography scan of his abdomen indicated mechanical small bowel obstruction. Preoperative preparations with administration of intravenously administered fluids and antibiotics were done for exploratory laparotomy. The operation was approached through a midline incision, revealing dilated small bowel loops with a terminal ileal loop occluded by a ring of his appendix. The appendicular tip was adherent to small bowel mesentery by adhesive band (appendiceal tourniquet). Release of the band with simple appendectomy was done; a segment of ileal bowel loop was congested but regained its viability after 5 minutes' application of gauze soaked in warm saline. His abdomen was closed in layers and one drainage tube left in situ. Paralytic ileus was the only postoperative complication which was relieved after 2 days. He was started on orally administered fluids on the third postoperative day, and discharged on the fifth postoperative day.

Conclusion: Acute appendicitis should be suspected as a cause of mechanical intestinal obstruction in an elderly patient with no obvious diagnostic cause, and can be managed with simple appendectomy when an early intervention is made.

Keywords: Acute appendicitis; Appendectomy; Appendiceal tourniquet; Closed loop intestinal obstruction; Elderly; Mechanical small bowel obstruction.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Intraoperative image. a Front view of the appendiceal tourniquet encircling the terminal ileal loop, base of the appendix (black arrow). b Back view of the appendiceal tourniquet, appendico-mesenteric band (white arrow)
Fig. 2
Fig. 2
Intraoperative image. a Division of the adhesive band. b Impression mark of the appendix over the mesentery
See this image and copyright information in PMC

References

    1. O’Donnell M, Sharif M, O’Kane A, Spence R. Small bowel obstruction secondary to an appendiceal tourniquet. Ir J Med Sci. 2009;178(1):101–105. doi: 10.1007/s11845-008-0125-3. - DOI - PubMed
    1. Hotchkiss LW. V. Acute intestinal obstruction following appendicitis. A report of three cases successfully operated upon. Ann Surg. 1901;34(5):660. doi: 10.1097/00000658-190107000-00070. - DOI - PMC - PubMed
    1. Bhandari L, Mohandas P. Appendicitis as a cause of intestinal strangulation: a case report and review. World J Emerg Surg. 2009;4(1):34. doi: 10.1186/1749-7922-4-34. - DOI - PMC - PubMed
    1. Gupta S, Vaidya M. Mechanical small bowel obstruction cause by acute appendicitis. Am Surg. 1969;35(9):670–674. - PubMed
    1. Harris S, Rudolf LE. Mechanical small bowel obstruction due to acute appendicitis: review of 10 cases. Ann Surg. 1966;164(1):157. doi: 10.1097/00000658-196607000-00018. - DOI - PMC - PubMed