Viable appendico-ileal knotting resulting in acute small bowel obstruction: a case report from Ethiopia

Appendico-ileal knotting is a rare cause of small bowel obstruction, usually complicated by strangulation and resection of bowel. A 32-year-old woman presented with 24-hour abdominal pain, bilious vomiting, distension, and obstipation. Visible peristalsis was noted on physical examination; a radiograph showed multiple air-fluid levels and a dilated small bowel. Emergency laparotomy revealed an inflamed appendix, which formed a constricting ring around a loop of 15 cm of distal ileum, which was viable. The knot was released with retrograde appendectomy without bowel resection. A follow-up 1 year later revealed no complications and a complete recovery. Early recognition and appropriate timely intervention can help in the preservation of bowel viability in appendico-ileal knotting, and hence organ-sparing management can be achieved.