Complete ileal obstruction secondary to a 22-year old non-absorbable suture for an open appendectomy: Clinical case report

INTRODUCTION

Small bowel obstruction (SBO) is a common surgical emergency. Our report describes a case of a 61-year-old male who was found to have a PROLENE suture left in situ from a previous open appendectomy 22 years ago, over which a fibrous adhesive band had formed, resulting in a terminal ileal volvulus and subsequent SBO.

CASE

A 61-year-old male presented with a 3-day history of severe lower abdominal cramps, nausea and constipation. A previous open appendectomy, performed 22 years ago, was the only significant detail in his medical history. A CT can with oral contrast was performed which showed dilatation of the terminal ileum and a complete absence of opacification of the cecum. Laparoscopy was then performed and a large adhesive band which formed over a suture from his previous open appendectomy was observed. On dissection of the adhesion, the bowel decompressed and returned to normal. Patient was discharged with no complications.

DISCUSSION

This is quite a unique case due to the structure of the adhesive band that was formed and the resulting terminal ileal volvulus which is an uncommon occurrence. We could not find any similar reports in our search of the literature and believe our report is novel in this regard.

CONCLUSION

We explored a novel etiology of adhesion formation over a foreign body left in situ and this should be considered by surgeons, especially when the clinical picture is uncommon such as a terminal ileal volvulus in this case.