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Laparoscopic management of an unusual case of small bowel obstruction: appendiculoileal knotting
  1. Prakhar Gupta,
  2. Subbaiah Rajapandian,
  3. Sandeep C Sabnis,
  4. Chinnusamy Palanivelu
  1. Department of MIS, GI and HPB Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India
  1. Correspondence to Dr Chinnusamy Palanivelu, info{at}


Appendicitis presenting at small bowel obstruction due to the formation of encircling loop around a bowel segment is a rare occurrence. We report such case managed with the laparoscopic approach. A 45-year-old woman presented to emergency services with severe pain in abdomen and bilious vomiting in the past 2 days, having a history of abdominal hysterectomy 10 years ago. The abdominal examination was suggestive of bowel obstruction. A CT showed dilated bowel loops with complete cut-off at the level of the terminal ileum. The patient was taken for diagnostic laparoscopy. The inspection of the small bowel revealed an appendicular looping around the small bowel lumen. After separating, the appendix obstruction was relieved. Then, the tip of the appendix was dissected free from the parietal wall along with approximately 5 mL purulent fluid. Appendectomy was completed and based looped doubly using catgut endoloop. The patient had an uneventful recovery and was discharged on the second postoperative day.

  • gastrointestinal surgery
  • general surgery

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  • Contributors All authors have contributed equally to the formation of this manuscript, in accordance with the guidelines of the International Committee of Medical Journal Editors. The individual contributions are as follows. PG: planning, conduct, reporting, conception and design, acquisition of data; SR: planning, conduct, reporting, conception and design, interpretation of data; SCS: conduct, reporting, conception and design, acquisition of data; PC: conduct, reporting, conception and design, interpretation of data.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.