Appendicitis Causing Small Bowel Strangulation a Rare Presentation– Three Case Reports

Abstract

A strangulation of the intestine caused by appendicitis is extremely rare with few cases reported in the literature. Strangulation can be due to the appendix wrapping or appendiceal tourniquet around the base of a bowel loop, or when inflamed appendix tip adheres across the loop of small bowel to the mesentery or long appendix tip attached to posterior wall forming a close loop, obstruction may lead to strangulation and gangrene of the bowel. The diagnosis of such a condition is possible only on the operation table, after midline explorative laparotomy. There are only 10 cases reported in the literature. Mechanical small bowel obstruction and strangulation is a very rare and dangerous complication of a very common disease of appendicitis required emergency laparotomy, to reduce the high mortality. Every emergency surgeon needs to be aware of such possibility. Herein we are reporting three cases of mechanical small bowel obstruction caused by appendicitis. Two patient were presented with as a strangulation of the small bowel, due to the long appendix causing constriction around a loop of the small bowel, acts as an appendiceal tourniquet or band syndrome, is an extremely rare surgical entity and third case presented with mechanical small bowel obstruction having an appendicular inflamed tip attached to the mesentery, producing constriction or compression of its ileum, producing the obstruction. In all cases we performed midline laparotomy with appendectomy and adhesiolysis.