Small bowel obstruction from an appendiceal tie.

Abstract

A 55‐year‐old female who was recently treated conservatively for appendicitis with phlegmon formation 4 months ago re‐presented to hospital with lower abdominal pain, nausea and vomiting. She recently had a colonoscopy and is currently awaiting interval appendicectomy. Her past medical history includes treated hepatitis C secondary to blood transfusion in the 1980s. On examination, her observations and laboratory parameters were within normal limits. On palpation, she had lower abdominal tenderness without guarding. Contrast‐enhanced computed tomography imaging demonstrated thick‐walled small bowel loops in the pelvis with a small amount of intra‐abdominal free fluid. The peri‐appendiceal phlegmon seen on previous computed tomography imaging had resolved (Fig. 1). A diagnostic laparoscopy was performed that demonstrated obvious small bowel obstruction. The transition point arose from the fibrous appendix that had adhered posteriorly into the retroperitoneum creating a bridge where terminal ileum herniating under this bridge became obstructed (Fig. 2). An appendicectomy was performed (Fig. 3). The patient was observed overnight in hospital and discharged the next day. Histopathological examination of the specimen confirmed a non‐inflamed appendix with fibrous obliteration. Informed consent was obtained from the patient to present this case.