title: Appendicitis as a rare cause of mechanical small-bowel obstruction: A literature review of case reports.
abstract: BACKGROUND
  Although bowel paralysis accompanying acute appendicitis is well known, mechanical bowel obstruction as a direct consequence of appendicitis remains a rare, but potentially life-threatening, acute abdomen. The aim of our literature review was to find all documented cases of this particular complication and compare them with our own case study.
  
  
  METHODS
  We searched the PubMed database for relevant articles published from 1963 to 2015. The study included patients for whom direct links between appendicitis and strangulation of the terminal ileum were found, and for which the disease course had been documented in detail. The study also included our own case report since it met the inclusion criteria. A total of 190 articles were examined with a final yield of 17 case reports from 13 articles.
  
  
  RESULTS
  17 patients (11 men and 6 women), with a mean age of 48±23.9years, met the inclusion criteria. The average period between symptom onset and surgery was 3.4±3.7 days. Symptoms of the disease were consistent with small-bowel obstruction. Treatment included simple appendectomy (n=7), possibly supplemented by segmental resection (n=5), followed by ileocecal resection (n=4), and one case that required a right-sided hemicolectomy (n=1).
  
  
  CONCLUSIONS
  We found mechanical bowel obstruction directly related to appendiceal inflammation to be extremely rare, and relatively few individual cases involving this potentially life-threatening complication have been documented in the literature. Clinical signs of the disease are variable, non-uniform, and consistent with symptoms of small-bowel obstruction during their progression.
authors.affiliation: Department of Military Surgery, Faculty of Military Health Sciences, University of Defense, Hradec Králové, Czechia; Surgical Clinic, University Hospital Hradec Králové, Hradec Králové, Czechia. Electronic address: ondrej.maly@fnhk.cz.
authors.forename: Ondřej
authors.initials: O
authors.lastname: Malý
authors.affiliation: Department of Military Surgery, Faculty of Military Health Sciences, University of Defense, Hradec Králové, Czechia; Surgical Clinic, University Hospital Hradec Králové, Hradec Králové, Czechia.
authors.forename: Jiří
authors.initials: J
authors.lastname: Páral
keywords: Acute abdomen; Appendicitis; Appendix; Bowel obstruction; Strangulation