Post-appendectomy Adhesive Small Intestine Obstruction With Gangrene: A Sinister Case

Abstract

Intestinal adhesions are fibrotic bands of scar tissue that develop intra-abdominally due to serosal or peritoneal irritation caused during surgery or by severe infections. It may also occur congenitally. It can lead to serious complications such as small bowel obstruction, which is then termed adhesive small bowel obstruction. In this scenario, it can constrict the bowel wall and cause ischemia and necrosis of the affected intestinal segment. Computed tomography imaging may show characteristic signs, such as the "whirl sign" or "fat-bridging sign." Diagnostic laparoscopy or laparotomy can confirm the diagnosis and presence of adhesions. Management of this condition is either conservative or surgical, the latter of which is necessary in the case of intestinal strangulation. While the literature supports the laparoscopic method of adhesiolysis, practically, it may present technical difficulties. Surgeons should employ their clinical judgment in cases where an open procedure may be more beneficial. We present a case of this very occurrence and discuss the risk factors, pathogenesis, diagnostic evaluation, and, finally, the approaches to surgical management of this condition.

Keywords: adhesions; band; gangrene; ischemia; obstruction; small intestine.

Figure 1. Circumferential wall thickening in multiple segments of the distal small bowel (axial view).

Figure 2. Twisted and dilated intestinal loops with non-enhancement of the affected segment (coronal view).

Figure 3. Enlargement of the adhesion band causing twisting of intestinal loops.

Figure 4. Post band release and detorsion of intestines showing compression effect resulting in gangrene of intestinal segment.

Figure 5. Resected segment of gangrenous intestine.