Strangulated Intestinal Obstruction due to Appendiceal Tourniquet: A Case Report

Makama JG, Kache SA and Baduku TS

Department of Surgery, Barau Dikko Teaching Hospital-KASU, Kaduna, Nigeria
Department of Radiology, Barau Dikko Teaching Hospital-KASU, Kaduna, Nigeria

^*Correspondance to: Makama JG 

 PDF  Full Text DOI: 10.25107/2474-1647.1436

Abstract

Background: Intestinal obstruction is regarded as one of the most common surgical emergencies with well known varied causes. Recently, acute appendicitis is being realised to be a significant cause. However, strangulation of the intestine caused by appendicitis is a rare occurrence. We, therefore, report a case of strangulated intestinal obstruction due to appendiceal tourniquet.
Materials and Methods: A case report and discussion of the relevant literature is presented.Case Report: H R is a 28-year old young man who presented with a 5 day history of sudden onset of abdominal pain which became generalised and worsened a day prior to presentation, was associated with abdominal distension, vomiting of bilious gastric effluent and constipation. There was no history of previous abdominal surgery. Physical examination revealed an ill-looking young man who was febrile and moderately dehydrated. The abdomen was distended and tender, with guarding and rigidity particularly in the region of the right iliac fossa. He had normal rectal findings. The rest of the physical examination was unremarkable. Laboratory investigations were within normal limits except leucocytosis due to Neutrophilia. Plain abdominal X-ray, erect and supine showed multiple air-fluid levels and dilated loops of bowel indicating small bowel obstruction. The patient was resuscitated and counseled for emergency exploratory laparotomy. Findings revealed a distended, near gangrenous loop of ileum occluded by a ring of an inflamed appendix which was fixed at the base and near the tip by adhesions. Appendicectomy was done to release the obstruction. Viability of the near gangrenous ileum was restored following a 5 minute application of gauze soaked in warm saline. The abdomen was closed in layers and patient had an uneventful recovery. Histology report of the appendix revealed features of appendicitis. He was doing well as at last visit to surgical outpatient department [SOPD], 6 month after operation.Conclusion: Acute appendicitis is an important cause of intestinal obstruction. Therefore a high index of suspicion is key to early recognition and treatment as simple appendicectomy may just suffice.

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Cite the article

Makama JG, Kache SA, Baduku TS. Strangulated Intestinal Obstruction due to Appendiceal Tourniquet: A Case Report. Clin Surg. 2017; 2: 1436.