Beyond the Appendix Stump: A Rare Case of Appendicular Band Syndrome Causing Small Bowel Obstruction

Postoperative adhesions present a complex surgical challenge, often leading to complications, such as small bowel obstruction (SBO). Among these, appendicular band syndrome, although rare, is a serious condition that underscores the importance of meticulous management of the appendix stump during surgery to prevent life-threatening outcomes. We report a case of a 67-year-old female who presented to the emergency department with post-prandial epigastric pain and vomiting. Notably, she did not open her bowels for the last 2 days. The patient had a medical history of hypertension and gastroesophageal reflux disease, and previous surgeries, including laparoscopic appendectomy and ovarian cystectomy. Computed tomography revealed a high-grade, incomplete SBO. Diagnostic laparoscopy revealed thick band adhesions arising from a residual appendiceal stump from previous appendectomy site, which had caused a clockwise torsion of jejunal loops; division of the band and completion appendicectomy resolved the obstruction. These findings highlights the complex interplay between surgical technique and stump length in preventing adhesion formation. The formation of adhesions is primarily initiate from disturbances to peritoneal mesothelial surfaces, triggering inflammatory and coagulation pathways. Our discussion delves into the optimal management of the appendix stump, highlighting current literature that suggests a stump length of approximately 5 mm as optimal for minimising the risk of both stump appendicitis and appendicular band adhesions. While traditional inversion of the stump may limit exposed mucosa, it is not universally recommended because an inverted stump can later mimic a caecal mass or create diagnostic uncertainty. When a laparoscopic endoloop technique is selected, achieving a critical view of the appendix with complete visualisation of the caeco-appendiceal junction before ligation, allows precise placement of the loop flush with the base, thereby keeping the residual stump short and reducing the risk of stump appendicitis. Identifying high-risk patients, with prior abdominal surgery or severe intra-operative inflammation, and tailoring stump management accordingly remain crucial to preventing complications, such as appendicular band syndrome.