Wondwosen Mekete, Tantu Temesgen, Zewdu Dereje
Department of Surgery, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
Department of Obstetrics and Gynecology, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
Int J Surg Case Rep. 2022 Apr;93:106970. doi: 10.1016/j.ijscr.2022.106970. Epub 2022 Mar 31.
Appendicitis causing intestinal obstruction by forming a knot around a small bowel is uncommon. Preoperative diagnosis is challenging as the typical presentations of appendicitis are not usually seen. The diagnosis of appendicular knotting is usually an intraoperative surprise.
A 34-year-old male patient (BMI-20.86 kg/m) presented to the surgical emergency unit with colicky central abdominal pain of 2-days duration, which later involved the whole abdomen. In association with this, he had a history of frequent vomiting of ingested matter which later became bilious. The abdominal examination revealed diffuse abdominal tenderness with guarding and rigidity. On midline exploratory laparotomy, the inflamed appendix which was adherent to the distal part of the ileum was observed. The appendix and the encircled segment of the distal ileum were both gangrenous, and the patient underwent resection of the bowel segment in addition to appendectomy.
Whenever an appendix wraps around an intestine or its tip adheres with small bowel, cecum, or posterior peritoneum forming a ring-like structure, and a segment of a bowel herniates through an opening can cause a closed-loop obstruction with or without strangulation. The management for ileo-appendicular knotting associated with gangrenous bowel could be appendectomy and resection of the bowel segment. Postoperatively, the patient had developed diarrhea caused by ileocecal resection, which later subsided by medication.
Ileo-appendicular knotting is a rare cause of small intestinal obstruction, and it's challenging to diagnose during the preoperative period. As surgeons dealing with acute abdomen in routine clinical practice, knowledge of this unusual case is helpful for clinical suspicion and evidence-based management.
阑尾炎通过在小肠周围形成纽结导致肠梗阻的情况并不常见。由于通常看不到阑尾炎的典型表现，术前诊断具有挑战性。阑尾纽结的诊断通常是术中意外发现。
一名34岁男性患者（BMI-20.86kg/m）因持续2天的阵发性中腹部疼痛就诊于外科急诊室，随后疼痛累及全腹。与此相关的是，他有频繁呕吐摄入物的病史，后来呕吐物变为胆汁样。腹部检查发现弥漫性腹部压痛伴肌紧张和强直。在中线剖腹探查术中，观察到发炎的阑尾与回肠远端粘连。阑尾和回肠远端被环绕的部分均已坏疽，患者除阑尾切除外还接受了肠段切除。
每当阑尾缠绕肠道或其尖端与小肠、盲肠或后腹膜粘连形成环状结构，且一段肠管通过一个开口疝出时，可导致有或无绞窄的闭环性肠梗阻。与坏疽性肠管相关的回盲部纽结的治疗方法可以是阑尾切除和肠段切除。术后，患者因回盲部切除出现腹泻，后来通过药物治疗缓解。
回盲部纽结是小肠梗阻的罕见原因，术前诊断具有挑战性。作为在日常临床实践中处理急腹症的外科医生，了解这种不寻常的病例有助于临床怀疑和循证管理。
