A 1-year 7-month-old boy presented with sudden onset of severe vomiting and abdominal pain. Barium enema revealed the caecum was elevated by a mass and the ileocaecal junction was visualised with a very short segment of terminal ileum showing a 'bird's-beak' appearance. At surgery, an unusually long necrotic appendix knotting the terminal ileum resulted in strangulation of a segment of the terminal ileum. There was no evidence of torsion of the terminal ileum or appendix. To our knowledge, this is the first case of the appendix knotting the terminal ileum resulting in a strangulated closed-loop obstruction.
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