An 81-year-old man presented with a 1-day history of right iliac fossa pain that radiated to the left iliac fossa. Vital signs were normal. Examination revealed abdominal distension with peritonism. An abdominal x-ray showed small bowel obstruction, and a computed tomography scan suggested a small bowel volvulus.
Laparotomy revealed a small bowel obstruction due to a pendulous appendix (20 cm in length) that had wrapped around a loop of bowel, causing obstruction and ischaemia (Figure).
The average length of the adult appendix is 7.5 cm in men and 6.7 cm in women (SD, 2.1 cm; range, 2–26 cm).1 Small bowel obstruction secondary to “appendiceal tourniquet” is extremely rare, with only 12 cases previously reported.2,3
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