An 81-year-old man presented with a 1-day history of right iliac fossa pain that radiated to the left iliac fossa. Vital signs were normal. Examination revealed abdominal distension with peritonism. An abdominal x-ray showed small bowel obstruction, and a computed tomography scan suggested a small bowel volvulus.
Laparotomy revealed a small bowel obstruction due to a pendulous appendix (20 cm in length) that had wrapped around a loop of bowel, causing obstruction and ischaemia (Figure).
Histopathological examination confirmed the presence of acute appendicitis with ischaemic small bowel. The patient recovered uneventfully.
The average length of the adult appendix is 7.5 cm in men and 6.7 cm in women (SD, 2.1 cm; range, 2–26 cm).1 Small bowel obstruction secondary to “appendiceal tourniquet” is extremely rare, with only 12 cases previously reported.2,3
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- Richard H Riley1
- Richard J Martin2
- 1 Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, WA.
- 2 Department of Surgery, Sir Charles Gairdner Hospital, Perth, WA.
- 1. Raschka S, Raschka C. [On the relationship between body dimensions and appendix length] [German]. Anthropol Anz 2008; 66: 67-72.
- 2. O’Donnell ME, Sharif MA, O’Kane A, Spence RA. Small bowel obstruction secondary to an appendiceal tourniquet. Ir J Med Sci 2009; 178: 101-105.
- 3. Assenza M, Ricci G, Bartolucci P, Modini C. Mechanical small bowel obstruction due to an inflamed appendix wrapping around the last loop of ileum. G Chir 2005; 26: 261-266.