High grade distal small bowel obstruction

Case contributed by Ian Bickle


Distended painful abdomen

Patient Data

Age: 70 years
Gender: Female

Lungs clear.

No free subdiaphragmatic gas.

Cholecystectomy clips.

Multiple dilated gas filled loops of small bowel in the central abdomen.  Collapsed large bowel.

The small bowel is fluid filled and markedly dilated down the distal ileum in the right iliac fossa.

Transition point in relation to a small collection related to a thickened and distended appendix with periappendiceal inflammatory change.

Normal upper abdomen.

A case of high grade distal small bowel obstruction secondary to acute appendicitis.

A laparotomy was performed and a appendectomy and small bowel resection undertaken.


Clinical Details:

Perforated appendicitis with chronic abscess and densely adherent small bowel with small bowel obstruction.

Specimen: Appendix, small bowel resection and omentum.

Macroscopic: 1. Appendix - appendix up to 50 mm in length with a central area of perforation. There is no evidence of neoplasia.

2. Small bowel resection - an irregular portion of small bowel up to 50 mm in length with stapled margins. There is focal external serosal inflammation. The mucosal surface appears normal. Representative sections were taken for histology.

3. Omentum - irregular fat up to 220 mm in maximum diameter. There are no focal abnormalities.

Microscopic: 1. An acute suppurative appendicitis with features consistent with local perforation and a consequential adjacent serositis. There is no evidence of neoplasia or endometriosis.

2. The small bowel shows variable serosal inflammation in keeping with an origin from close proximity to an adjacent external source of local inflammation. The small bowel mucosa appears normal with no evidence of any form of primary mucosal inflammatory process. There is no evidence of mucosal ischemia.

3. Normal omental fat.


1. Appendix - acute suppurative appendicitis with local perforation.

2. Small bowel resection - external serosal inflammation only.

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