Appendicular band syndrome leading to small bowel obstruction: A case report of a rare complication of acute appendicitis.

INTRODUCTION

Appendicular band syndrome is an extremely rare surgical emergency, and only a few cases have been reported in the literature. Although intestinal obstruction comprises 2 % - 8 % of the cases of acute abdomen presenting to emergency, obstruction due to appendicular band syndrome is a rare entity.

CASE REPORT: A 43-year-old male presented with features suggestive of small bowel obstruction for 5 days. On examination, the abdomen was distended and tense with generalized mild tenderness all over the abdomen. CECT (abdomen and pelvis) showed a transition point in the distal ileum, with dilated bowel loops proximal to it. On exploratory laparotomy, the appendix was found completely encircling the distal ileum, forming a constricting band, for which release of appendicular band with appendectomy was done.

DISCUSSION: The initiating event in appendicular band syndrome is acute appendicitis itself. Due to the inflammation of appendix, its tip gets adhered to the caecum, retro-peritoneum, ileal mesentery, or ileum itself, forming a potential gap. A segment of bowel may herniate through this gap and become entrapped, resulting in closed-loop obstruction and subsequent strangulation. In the absence of bowel strangulation, releasing the appendicular band along with appendectomy is sufficient. However, if the bowel loop is found to be gangrenous, resection with primary anastomosis is warranted.

CONCLUSION

Appendicular band syndrome, often diagnosed intraoperatively, should be kept in mind as one of the differential diagnoses when evaluating patients with features of bowel obstruction. Early diagnosis guides incision planning, while timely surgical intervention is crucial for preventing serious complications.