Skip to main content
Log in

Small bowel obstruction secondary to an appendiceal tourniquet

  • Case Report
  • Published:
Irish Journal of Medical Science Aims and scope Submit manuscript

Abstract

Background

An 83-year-old lady was admitted with a 3-day history of non-specific abdominal pain that had rapidly increased in severity on the day of admission necessitating an emergency laparotomy. Intra-operative findings demonstrated a mechanical small bowel obstruction secondary to a chronically inflamed appendix acting as a tourniquet around a loop of terminal ileum.

Learning point

This case highlights an extremely rare and life-threatening complication of appendicitis.

Literature review

True mechanical small bowel obstruction secondary to an acutely or chronically inflamed appendix encircling the distal small bowel remains extremely rare with only ten cases reported in the literature.

Conclusion

Clinical assessment remains paramount in the treatment of these patients to facilitate prompt diagnosis and treatment which is vital to provide an optimal platform for post-operative recovery and survival. Although CT imaging is a highly effective investigative modality in these cases, operative treatment should not be delayed for a radiological investigation in the presence of abdominal peritonism.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Adiss DG, Shaffer N, Fowler BS, Tauxe RV (1990) The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 132:910–925

    Google Scholar 

  2. Assenza M, Ricci G, Bartolucci P, Modini C (2005) Mechanical small bowel obstruction due to an inflamed appendix wrapping around the last loop of ileum. G Chir 26:261–266

    PubMed  CAS  Google Scholar 

  3. Luckman R (1989) Incidence and case fatality rates for acute appendicitis in California. A population-based study of the effects of age. Am J Epidemiol 129:905–918

    Google Scholar 

  4. Paajanen H, Kettunen J, Kostiainen S (1994) Emergency appendectomies in patients over 80 years. Am Surg 60:950–953

    PubMed  CAS  Google Scholar 

  5. Fevang BT, Fevang J, Strangeland L, Søreide O, Svanes K, Viste A (2000) Complications and death after surgical treatment of small bowel obstruction: a 35-year institutional experience. Ann Surg 231:529–537

    Article  PubMed  CAS  Google Scholar 

  6. Balthazar EJ, Liebeskind ME, Macari M (1997) Intestinal ischaemia in patients in whom small bowel obstruction is suspected: evaluation of accuracy, limitations, and clinical implications of CT in diagnosis. Radiology 205:519–522

    PubMed  CAS  Google Scholar 

  7. Naumon ID (1963) Two cases of strangulation of the small intestine in the loop of the appendix. Khirurgiia (Mosk) 39:130–132

    Google Scholar 

  8. Srivastan M (1964) Intestinal obstruction caused by a long appendix ensnaring a loop of ileum. J Med Ind Ass 43:400–401

    Google Scholar 

  9. Paliwal YD, Singh RP (1969) An unusual complication of appendix (intestinal obstruction)—case report. Indian J Surg 31:288

    Google Scholar 

  10. Gupta S, Vaidya MP (1969) Mechanical small bowel obstruction caused by acute appendicitis. Am Surg 35:670–674

    PubMed  CAS  Google Scholar 

  11. Bose SM, Talwar BL (1973) Appendicitis causing acute intestinal obstruction with strangulation. Aust NZ J Surg 43:56–57

    Article  CAS  Google Scholar 

  12. Ivoulsou DP, Agounkagou M (1996) Un cas d’occlusion du grele sur strangulation par appendice vermiculare. Med Trop 56:413–414

    CAS  Google Scholar 

Download references

Acknowledgments

We thank Mr. Ragai Makar, Department of Surgery, Belfast City Hospital for his assistance in French translation and Ms. Anna Kulakova, Department of Biochemistry, Medical Biology Centre, Northern Ireland for her assistance in Russian translation.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to M. E. O’Donnell.

Rights and permissions

Reprints and permissions

About this article

Cite this article

O’Donnell, M.E., Sharif, M.A., O’Kane, A. et al. Small bowel obstruction secondary to an appendiceal tourniquet. Ir J Med Sci 178, 101–105 (2009). https://doi.org/10.1007/s11845-008-0125-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11845-008-0125-3

Keywords

Navigation