Appendiceal Tie Syndrome

Excerpt

A 65-year-old lady presented with 3-day of generalised abdominal pain and distension. She has been suffering from nausea and vomiting. She has not been passing flatus and has been obstipated. Her only past medical history includes hysterectomy for fibroids. On presentation, her vital signs were normal and afebrile. Clinical examination revealed a lower midline incision, distended, soft, and non-tender abdomen. Laboratory tests showed normal inflammatory markers, renal function, and lactate level. A computed tomography (CT) of the abdomen/pelvis was organised and showed small bowel obstruction (SBO) with transition in right lower quadrant without features of ischemia. Non-operative management was initiated for adhesive SBO with fluid resuscitation, insertion of nasogastric tube, and administration of water-soluble contrast agent. An abdominal x-ray 6 h later showed persistent SBO and the contrast agent remained in the small bowel. She was taken to the operating theatre. A diagnostic laparoscopy was attempted but then converted to lower midline laparotomy. The appendix was adherent to the right pelvic side wall forming an internal hernia where the terminal ileum was incarcerated within it (Fig. 1). The appendiceal adhesion was divided. The incarcerated terminal ileum was slightly haemorrhagic but viable. Appendicectomy was performed. She recovered uneventfully post-operatively.

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