Gangrenous small bowel obstruction resulting from appendico-ileal knotting: a rare case report from Bete Markos Medical and Surgical Center, Ethiopia.

Appendico-ileal knotting (AIK) is a rare and often overlooked cause of small bowel obstruction (SBO), frequently mimicking conditions like perforated appendicitis. We report a case of a 28-year-old Ethiopian male presenting with acute lower abdominal pain, nausea, anorexia, and bilious vomiting. Imaging suggested SBO, and emergency laparotomy revealed 1.5 l of hemorrhagic ascites and a gangrenous distal ileum caused by a 20 cm gangrenous appendix wrapped around the ileum. Surgical treatment involved untwisting the knot, appendectomy, resection of 1 m of ileum, and ileo-transverse anastomosis. The patient recovered well and was discharged on postoperative Day 6. AIK should be considered in SBO cases without previous abdominal surgery, and early surgical intervention is crucial to avoid complications.