Appendico-ileal knotting: a rare cause of small bowel obstruction diagnosis and management in a resource-limited setting; case report

Abstract

Introduction and importance: Appendico-ileal knotting, a rare cause of small bowel obstruction, presents a unique surgical challenge. Due to its nonspecific clinical manifestations and the limited diagnostic resources available, especially in resource-limited settings, patient outcomes are often significantly impacted. In this case report, we present the diagnosis and management of a 55-year-old male with appendicoileal knotting. We aim to emphasize the importance of early intervention in improving patient outcomes.

Clinical presentation: A 55-year-old farmer from a rural area in Northwest Gondar, Ethiopia was referred to our tertiary hospital for further investigation and management after initially visiting a primary hospital. He presented with crampy abdominal pain lasting one week, initially periumbilical and later shifting to the right lower quadrant. This was associated with non-bilious vomiting 2-3 times per day for six days, along with anorexia. One day prior to presentation, the vomiting became bilious, occurring 2-3 times per day, and he began experiencing an inability to pass feces and flatus.

Clinical discussion: Small bowel obstruction is one of the most commonly encountered surgical conditions in clinical practice and a leading cause of surgical intervention. Common causes of small bowel obstruction include adhesions, postoperative ileus, and volvulus. We may occasionally encounter rarer causes of small bowel obstruction, such as appendicoileal knotting.

Conclusion: Although appendiceal knotting is a rare cause of small bowel obstruction, it remains a potential etiology. Due to the nonspecific clinical presentations and limited diagnostic modalities in resource-limited areas, a high degree of suspicion is crucial for improving outcomes.

Keywords: Appendicitis, case report; Appendicoileal knotting; Small bowel obstruction.