Abstract
BackgroundAcute 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 presentationWe 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.ConclusionAcute 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.
Highlights
Acute appendicitis is known to cause intestinal obstruction
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
We report a rare case of closed loop small bowel obstruction due to acute appendicitis, managed by simple appendectomy through laparotomy
Summary
Acute appendicitis may lead to mechanical small bowel obstruction, manifesting as either open or closed loop type (AT). AT occurs mainly in elderly patients with predominant features of intestinal obstruction. Examination and laboratory investigations are not helpful in indicating presence of appendicitis. A high index of suspicion for AT is recommended in elderly patients with mechanical intestinal obstruction with no obvious cause. Surgical intervention prevents the bowel from becoming gangrenous, and appendectomy is sufficient to relieve the obstruction
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