A CASE OF INTESTINAL OBSTRUCTION DUE TO TANGLE

Abstract

A 78-year-old man was admitted to the hospital because of severe abdominal pain lasting for two day. There was a history of undergoing an appendectomy 30 years before and having brain infarction 13 years before admisson. Physically, remarkable abdominal distension and reduced bowel sound were noted, however, no muscular deffence was recognized. Abdominal X-ray CT scanograms showed a severe calcification of the superior mesenteric artery and significant dilatation of the small intestine. The patient took an urgent course into shock for an hour. We diagnosed the case as embolism of the superior mesenteric artery, and an emergency laparotomy was performed. Intraoperatively, it was noticed that the ileum was obstructed by many pieces of tangles at a kinked site due to the previous appendectomy. Ileotomy was performed and the tangle pieces were removed. However, he could not recover from shock and died two days after the operation. We asked his family menber about his eating habits and it was clarified that he ate a lot of tangle's roots, 'ne-konbu' one week before admission. Small intestinal obstruction with tangle is a rare entity and we found a great deal of difficulty in preoperative diagnosis.