Abstract
An 80-year-old man admitted to our hospital for fever and abdominal pain had previous histories of undergoing gastrectomy for gastric ulcer at the age of 24 and operation for spinal arteriovenous malformation at 42, and thereafter he had had paraplegia and vesicorectal dysfunction. Abdominal computed tomography showed a 7×5×4 cm enhanced solid tumor in the pelvic cavity. Gastrointestinal stromal tumor (GIST) of the small intestine was suspected. We examined small bowel series but no obvious lesion was detected. He developed ileus after the examination. We employed an emergent operation because conservative therapy was ineffective. Laparotomy disclosed a strangulated and dilated intestine consisting of a loop structure at 20cm proximal to the terminal ileum. This structure was caused by a ring-shaped appendix which adhered to the ascending colon on the apex. Only appendectomy was performed against ileus because intestinal strangulation was released and no necrosis was present. In addition, small bowel resection for the ileal tumor 120cm proximal to the ileocecal junction was performed. The strangulated ileus caused by a ring-shaped appendix is very rare. Only seven cases of strangulation ileus caused by the appendix have been reported in Japan, and our case is the only one without relating to mucocele of the appendix.
