# Viable appendico-ileal knotting resulting in acute small bowel obstruction: a case report from Ethiopia

## TL;DR

A 32-year-old woman in Ethiopia had a rare case of appendico-ileal knotting causing bowel blockage, successfully treated without removing part of her intestine.

## Contribution

This case report highlights a successful organ-sparing surgical approach for a rare cause of small bowel obstruction.

## Key findings

- Appendico-ileal knotting was diagnosed as the cause of acute small bowel obstruction.
- The knot was released without bowel resection, preserving intestinal viability.
- The patient had no complications and fully recovered one year post-surgery.

## Abstract

Appendico-ileal knotting is a rare cause of small bowel obstruction, usually complicated by strangulation and resection of bowel. A 32-year-old woman presented with 24-hour abdominal pain, bilious vomiting, distension, and obstipation. Visible peristalsis was noted on physical examination; a radiograph showed multiple air–fluid levels and a dilated small bowel. Emergency laparotomy revealed an inflamed appendix, which formed a constricting ring around a loop of 15 cm of distal ileum, which was viable. The knot was released with retrograde appendectomy without bowel resection. A follow-up 1 year later revealed no complications and a complete recovery. Early recognition and appropriate timely intervention can help in the preservation of bowel viability in appendico-ileal knotting, and hence organ-sparing management can be achieved.