# Complete ileal obstruction secondary to a 22-year old non-absorbable suture for an open appendectomy: Clinical case report

## TL;DR

A man developed a bowel blockage 22 years after an appendectomy due to a suture left in his body, forming a fibrous band that caused a rare type of intestinal twist.

## Contribution

This case report presents a novel and rare cause of small bowel obstruction due to a long-retained suture causing terminal ileal volvulus.

## Key findings

- A PROLENE suture left in situ after an open appendectomy caused a fibrous band leading to terminal ileal volvulus.
- The patient's symptoms were resolved after laparoscopic dissection of the adhesion.
- This case highlights the importance of considering foreign bodies in atypical cases of small bowel obstruction.

## Abstract

Small bowel obstruction (SBO) is a common surgical emergency. Our report describes a case of a 61-year-old male who was found to have a PROLENE suture left in situ from a previous open appendectomy 22 years ago, over which a fibrous adhesive band had formed, resulting in a terminal ileal volvulus and subsequent SBO.

A 61-year-old male presented with a 3-day history of severe lower abdominal cramps, nausea and constipation. A previous open appendectomy, performed 22 years ago, was the only significant detail in his medical history. A CT can with oral contrast was performed which showed dilatation of the terminal ileum and a complete absence of opacification of the cecum. Laparoscopy was then performed and a large adhesive band which formed over a suture from his previous open appendectomy was observed. On dissection of the adhesion, the bowel decompressed and returned to normal. Patient was discharged with no complications.

This is quite a unique case due to the structure of the adhesive band that was formed and the resulting terminal ileal volvulus which is an uncommon occurrence. We could not find any similar reports in our search of the literature and believe our report is novel in this regard.

We explored a novel etiology of adhesion formation over a foreign body left in situ and this should be considered by surgeons, especially when the clinical picture is uncommon such as a terminal ileal volvulus in this case.

•Small bowel obstruction (SBO) is a common surgical presentation.•Adhesions are the most common cause of small bowel obstruction.•61-year-old male with a previous open appendectomy presented with SBO.•SBO caused by adhesive band formed around terminal ileum resulting in terminal ileal volvulus.•Found to have had a PROLENE suture left in place from previous appendectomy, over which an adhesive band formed•Important learning point that foreign bodies should be considered in the etiology of uncommon sites of SBO such as a terminal ileal volvulus in this case

Small bowel obstruction (SBO) is a common surgical presentation.

Adhesions are the most common cause of small bowel obstruction.

61-year-old male with a previous open appendectomy presented with SBO.

SBO caused by adhesive band formed around terminal ileum resulting in terminal ileal volvulus.

Found to have had a PROLENE suture left in place from previous appendectomy, over which an adhesive band formed

Important learning point that foreign bodies should be considered in the etiology of uncommon sites of SBO such as a terminal ileal volvulus in this case