Strangulated Internal Hernia through Appendicular Tourniquet/Ring: Unusual Cause of Intestinal Obstruction

Patient: Male, 24-year-old Final Diagnosis: Internal hernia Symptoms: Abdominal distension • abdominal pain • dizziness • peritonitis Medication: — Clinical Procedure: Laparotomy Specialty: Surgery OBJECTIVE: Rare disease BACKGROUND: Intestinal obstruction secondary to internal hernia is a rare phenomenon in adults particularly in patients with history of pulmonary tuberculosis, but commonly seen in pediatric population. Mostly it occurs along the duodenum in the paraduodenal recesses. The patient might be misdiagnosed as having obstruction secondary to strictures formed as a result of intestinal tuberculosis and pose delay in exploration. CASE REPORT: We describe an adult patient who presented with intestinal obstruction by a tourniquet or ring formed between the tip of appendix and ileocecal junction through which small bowel herniated, strangulated and finally perforated before exploration, initially thought to be due to intestinal tuberculosis. He underwent exploratory laparotomy and was release of obstruction, appendectomy and resection of bowel. The patient tolerated the procedure well and discharged in stable condition. CONCLUSIONS: Intestinal obstruction due to internal hernia is rare in adults. Computed tomography abdomen can diagnose the condition; however, exploration of the abdomen can give the definite diagnosis and tailor the appropriate therapy.