Appendiceal abscess complicated by mechanical small-bowel obstruction: a diagnostic and therapeutic challenge: A case report

RATIONALE: Appendiceal abscesses are typically managed conservatively. Mechanical small-bowel obstruction (MSBO) is a rare complication that poses diagnostic and therapeutic dilemmas. PATIENT CONCERNS: A 52-year-old woman with appendiceal abscess, which also manifested as symptoms of intestinal obstruction, was finally confirmed to have MSBO intraoperatively. DIAGNOSES: Appendiceal abscess, MSBO. INTERVENTIONS: The patient presented with 5-day migratory right lower quadrant pain. Initial computed tomography suggested appendicitis with possible small-bowel obstruction. Despite the use of aggressive antibiotics and electrolyte correction, the patient developed vomiting, obstruction, and worsening abdominal distension. A repeat computed tomography scan (day 6) confirmed appendiceal abscess with MSBO. Emergency laparoscopy was converted to laparotomy, which revealed a phlegmonous mass compressing the terminal ileum. Intraoperative frozen sections were used to exclude malignancy, and ileocecal resection with ileo-ascending colonic anastomosis was performed. The patient recovered uneventfully after the procedure. OUTCOMES: The patient resumed bowel function on postoperative day 3 and was discharged on postoperative day 9. At the 6-month follow-up, the patient did not experience any discomfort. LESSONS: MSBO should be suspected when obstruction persists despite appropriate conservative treatment. An appendiceal abscess combined with MSBO requires early surgical intervention when conservative therapy fails. Timely imaging reassessment and multidisciplinary decision-making are critical to avoid delayed management.