A case report of an ileo-appendicular knotting causing strangulated small bowel obstruction

Ileal strangulation is a rare condition that leads to upper intestinal obstruction. It is difficult to diagnose preoperatively and requires urgent medical and surgical management. We report the management of a case of appendicular knot on the ileum.

A 52-year-old patient was seen for an occlusive syndrome evolving in a febrile context, with a biological inflammatory syndrome. The diagnosis was mesocoeliac appendicitis. Imaging was not performed due to lack of access. Laparotomy revealed the necrotic ileal loop, strangulated by an inflammatory appendix. An ileo-caecal resection with terminal ascending ileo-colic anastomosis and cleaning of the peritoneal cavity were performed. Postoperative management was straightforward.

Strangulation of the terminal ileum by the appendix is a rare entity causing upper intestinal obstruction by strangulation. We report the 5th case in the literature from sub-Harienne Africa. The etiopathogenesis of this condition is believed to be appendicular length and inflammation. The pathophysiology describes 04 mechanisms, depending on the topography of the appendix. Surgical management is not codified, and depends on intraoperative findings.

Appendiceal strangulation of the ileum is a serious condition requiring complex preoperative diagnosis. It is a medical and surgical emergency requiring rapid management.