A Tangled Diagnosis: Appendiceal Knotting in Small Bowel Obstruction

Abstract

Small bowel obstruction (SBO) and acute appendicitis individually represent common etiologies of acute abdominal presentations across diverse age demographics. However, the co-occurrence of SBO secondary to acute appendicitis, wherein an inflamed appendix forms a constrictive knot around the small bowel, remains exceptionally rare. This phenomenon, first described by Hotchkiss in 1901, has since been sparsely documented in medical literature, presenting considerable diagnostic challenges due to its subtle clinical manifestations. Discussion surrounding this rare occurrence underscores the importance of prompt diagnosis and intervention in cases of acute SBO, particularly when etiological factors such as appendiceal banding are implicated. Despite advancements in imaging modalities, definitive diagnosis often necessitates surgical exploration, emphasizing the limited utility of preoperative imaging in identifying such obscure pathologies. Herein, we present the case of a 70-year-old patient, wherein the inflamed appendix had formed a ring around the caecum, resulting in the herniation of the terminal ileum and subsequent bowel obstruction.