Closed loop obstruction and appendicular stump mucocele

Case contributed by Dr Safwat Mohammad Almoghazy


Presented with a one-day history of acute abdominal colicky pain with distention and nausea. Past history of appendectomy 4 years ago.

Patient Data

Age: 50 years
Gender: Male

Following signs are demonstrated on this CT:

  • marked distension of a segment of small bowel
  • radially distributed, C or U-shaped small bowel loops
  • "beak sign": of the tapering bowel loops at the point of obstruction
  • "whirl sign": of the tightly twisted mesentery
  • two adjacent collapsed loops of bowel

Closed ileal bowel loop obstruction is suggested with strangulation and right iliac fossa appendicular mucocele.


post right hemicolectomy

Evidence of post operative right hemicolectomy changes with mild congested mesenteric vessels and the mild streaky fat density in the right hypochondrium region are seen suggestive of postoperative changes.

Midline anterior abdominal wall postoperative incision with no remarkable lesions seen within. No ascites is seen.​​

Case Discussion

The patient presented one-day history acute abdominal pain (colicky), distention, and nausea and a past history of appendectomy 4 years ago.

CT abdomen performed as an emergency showed: closed ileal bowel loop obstruction with strangulation and right iliac fossa appendicular stump forming a mucocele.

Laparotomy was done showed a segment of ileum was gangrenous, the appendicular stump was edematous with gelatinous material within it, resection anastomosis was done and an appendicular stump resection.

Histopathology: Low-grade mucinous neoplasm of the appendix with positive proximal margin.

The case discussed with medical oncology and advised to do right hemicolectomy. 

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Case information

rID: 54014
Published: 19th Aug 2017
Last edited: 20th Aug 2017
Inclusion in quiz mode: Included

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