Mechanical small bowel obstruction secondary to acute appendicitis

Mechanical small bowel obstruction (SBO) secondary to acute appendicitis is rare, described only in isolated reports. Herein we present a photo-documented case illustrating this mechanism. A 39-year-old female presented postoperative day 6 from laparoscopic myomectomy with periumbilical abdominal pain and distention. Computed tomography showed possible SBO, and after 24 h without improvement, exploratory laparoscopy was performed revealing a necrotic-appearing appendix completely encircling and obstructing the small bowel proximal to the terminal ileum. Appendectomy was performed facilitating patient recovery. Acute appendicitis can cause SBO through several mechanisms. Mechanical obstruction by an inflamed appendix is a rare etiology that's been variably called appendicular knot, appendico-ileal knot, appendicular band syndrome, or appendicular tie syndrome. This may be associated with closed-loop obstruction and bowel strangulation warranting prompt surgery. Although rare, acute appendicitis should be considered as a possible cause of SBO of unknown etiology.