EP187 - Can appendiceal adhesions cause small bowel obstruction? A rare case presentation managed laparoscopically

Abstract Aims Adhesions are the commonest cause of small bowel obstruction world-wide. However, a band adhesion from the appendicular tip to the small bowel causing small bowel obstruction is rarely reported in literature. We report such a presentation and successful management by laparoscopic approach with good outcome. Methods 61-year-old female, presented with abdominal pain, mild distension & vomiting for 3-days. She had undergone ultrasound-guided-drainage of appendicular abscess 3-months ago. CTAP showed small-bowel obstruction with transition point in pelvis - possible cause being adhesions. After initial conservative management, since she was not improving for 2-days, she was consented for diagnostic laparoscopy. Results Intraoperatively, an adhesive band was found between the appendicular tip and distal ileum around 100cm proximal to Ileo-colic junction, resulting in mechanical bowel obstruction. Laparoscopic division of band was performed followed by appendicectomy, and patient had an uneventful recovery and discharged on post-operative day-2. Conclusion Though an uncommon cause of adhesive small bowel obstruction, a band from appendicular tip causing mechanical bowel obstruction can be managed effectively by laparoscopic approach. In future when dealing with complications of appendicitis, like appendicular abscess - it needs to be addressed with clinical suspicion in such presentations.