Appendicoileal knotting and Appendicoileal fistula in a-13-year-old child: rare complication of appendicitis: A case report

Abstract

Introduction: Acute appendicitis is an inflammation of the appendix, which is the most common abdominal surgical emergency. If left untreated, appendicitis can rupture with abscess formation. Rarely, it can lead to fistula formation in other organs or form a knot and cause bowel obstruction. Both appendicitis knot and appendicoileal fistula occurrence in the same patient are rare complications of acute appendicitis.

Case presentation: We present the first case of appendicoileal knot with appendicoileal fistula in a 13-year-old male patient who presented with abdominal distension of 3 days duration with failure to pass feces and flatus and crampy abdominal pain. Abdominal examination revealed a distended abdomen, visible bowel loops, and tenderness at the lower abdomen bilaterally. Multiple air-fluid levels were seen on an erect abdominal X-ray.  With a diagnosis of small bowel obstruction, he underwent exploratory laparotomy. Intraoperative, the appendix was wrapped around a loop terminal ileum and its tip had fistulous communication with the ileum. For this appendectomy and ileal resections with end-to-end anastomosis were done.

Conclusion: Appendicoileal knot and/or fistula formation should be expected as a cause for small bowel obstruction in patients with appendicitis. Laparotomy is the treatment modality for patients with bowel obstruction due to appendicitis.