The knotted appendix: an unusual cause of bowel obstruction: a case report

Abstract

Small bowel obstruction (SBO) is a common surgical emergency, but appendico-ileal knotting is an exceptionally rare cause. This condition involves the appendix forming a constricting loop around the ileum, potentially leading to closed-loop obstruction and bowel ischemia. We report the case of a 57-year-old male from Ethiopia who presented with classical features of SBO, including abdominal pain, bilious vomiting, and failure to pass stool and flatus. Imaging was inconclusive, and an exploratory laparotomy revealed appendico-ileal knotting involving the terminal ileum. The bowel was viable, and a simple appendectomy was performed. The patient had an uneventful recovery and was discharged on postoperative Day 5. Histopathology confirmed acute appendicitis with mucocele. This case underscores the diagnostic challenge of this rare condition and emphasizes the need for early surgical intervention to avoid complications.

Keywords: appendicular knot; case report; small bowel obstruction; strangulated.

Figure 1

Abdominal radiograph showing multiple distended loops of small bowel.

Figure 2

The appendix (black arrow) encircling the loops of terminal ileum (green arrow) with dilatation of proximal bowel loops (blue arrows).

Figure 3

Showing the appendix with multiple cystic mass.