Appendicular knot causing closed-loop obstruction, volvulus and strangulation of ileum in a 9-year-old: a case report

Abstract

Appendicular knot/tie syndrome is a rare cause of mechanical intestinal obstruction. It is rarer still in the paediatric age group. We present the case of a 9-year-old boy admitted with clinical features and radiological evidence of acute intestinal obstruction, which at laparotomy revealed an inflamed/gangrenous knotted appendix, ileal volvulus and strangulation. This is a ‘three in one’ case of acute abdomen associated with appendicoileal knotting. In the presence of viable ileum, a retrograde appendectomy was performed. Postoperative period and follow-up were uneventful. Appendicular knot/ band syndrome should be considered a possible differential in acute intestinal obstruction. Computed tomographic scan as an investigative modality should be selective in the presence of acute intestinal obstruction with or without peritonitis, with emphasis on adequate resuscitation and surgery.

Keywords: appendix, appendicular tie/knot syndrome, intestinal obstruction, volvulus, strangulation