Complete torsion of the appendix leading to small bowel obstruction: a rare case report

We present a rare case of appendiceal tourniquet-related mechanical small bowel obstruction caused by a 360-degree torsion of the appendix around the small bowel mesentery, representing an unusual manifestation of appendiceal pathology.

A 55-year-old woman presented with acute abdominal distension, bilious vomiting, and radiographic evidence of small-bowel obstruction (SBO). An emergency laparotomy revealed a 360-degree torsion of the appendix around the small-bowel mesentery, creating a mechanical point of obstruction without evidence of secondary pathology. The patient underwent a successful emergent appendectomy with complete resolution of symptoms.

This case highlights several important findings. Appendiceal pathology may rarely present as a mechanical small bowel obstruction rather than presenting with the typical clinical features of acute appendicitis. In our patient, the mechanism was most consistent with a closed-loop appendiceal tourniquet phenomenon caused by torsion of the appendix around the small bowel mesentery, resulting in a mechanical obstruction. The case also demonstrates that prompt surgical intervention by appendectomy can achieve complete resolution and an excellent clinical outcome. Emergency laparotomy revealed a 360-degree torsion of the appendix around the small bowel mesentery, causing a mechanical point of obstruction without evidence of secondary pathology. The patient underwent a successful emergent appendectomy with complete resolution of symptoms. Histopathological examination demonstrated ischemic and hemorrhagic changes consistent with appendiceal torsion, without evidence of appendicitis, neoplasia, or other underlying pathology.

The rarity of this condition poses diagnostic challenges, as conventional imaging may not identify the torsed appendix preoperatively. This report expands the differential diagnosis for mechanical SBO and emphasizes the importance of considering atypical appendiceal pathology in acute abdominal emergencies. Our experience suggests that appendectomy remains the definitive treatment when torsion is identified intraoperatively, with excellent outcomes achievable through timely intervention.