A rare cause of small bowel obstruction - a case report

Dr. M.Sivan; Dr. K.Surendar; Prof.P.Thangamani; Prof.R.Kannan

Volume : IX, Issue : II, February - 2020

A rare cause of small bowel obstruction - a case report

Dr. M. Sivan, Dr. K. Surendar, Prof. P. Thangamani, Prof. R. Kannan

Abstract :

We report a case of a 62 year old male patient presented with complaints of diffuse abdominal pain,abdominal distension,bilious vomiting for one week and obstipation for 2 days.On examination, patient had distended abdomen with diffuse tendermess and guarding. X ray Abdomen erect and supine showed dilated small bowel loops with multiple air fluid levels. Contrast CT of Abdomen showed Partial small bowel obstruction with transition point 8–10cms from ileocaecal valve. Diagnostic laparoscopy showed Inflammed appendix epiploicae from mid transverse colon extending upto a point 10 cm from DJ flexure attached to a necrotic mesentric node obstructing the distal ileum.Distal portion of inflammed appendix epiploicae divided with lap harmonic scalpel and clips applied over the stump.Cut end of inflammed appendix epiploicae receeded and could not be traced laparoscopically.Hence mini – laparotomy made and thorough laparotomy done.Inflammed appendix epiploicae over the transverse colon is identified , ligated and excised in toto , sent for HPE.The distal end of the band is identified and found to be attached to necrotic lymphnode.Post operatively patient was stable, started on oral diet on post–operative day 2 and no further complaints.