Amal Gamdi, Sheikh Muddasir, Mahmoud Tolba, Saleem Abdul Sattar Khan.
Acute gangrenous appendicitis presenting as acute intestinal obstruction.
Pak J Surg Jan ;36(1):99-101.

Acute appendicitis is the most common surgical emergency, the diagnosis is often missed, when acute appendicitis present with features of acute intestinal obstruction. The diagnosis of acute appendicitis creates a diagnostic dilemma if it presents with history of abdominal pain, vomiting and abdominal distension. On examination patients present with distended abdomen with tenderness all around. We should have high index of suspicion to diagnose acute appendicitis when it present with features of intestinal obstruction. We present a case of a 53 years old male who has known history of type-II Diabetes mellitus. He presented to King Abdullah Hospital, Bisha with history of abdominal pain, abdominal distension, vomiting and constipation since last 2 days. His investigation shows (RBS 350, pH was 7.2, HCO3 was 11 and lactate was 2.6). His Diabetic Ketoacidosis treated by DKA protocol, His X-ray abdomen suggestive of dilated bowel loops, CT scan with oral gastrograffi n contrast suggestive of small bowel obstruction. Patient underwent laparotomy and the findings were, acute suppurative appendicitis with small bowel obstruction. Appendectomy done and small bowel deflated. Patient was shifted to ICU for 2 days and shifted to surgical ward on 3rd post-operative day.

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