In 1908, Forbes Hawks divided them into mechanical, septic and a combination of the two [2]. After a thorough review of literature, we found that the underlying pathology in intestinal obstruction caused by Pexidartinib clinical trial appendicitis could be classified into: 1. Adynamic   2. Mechanical (without strangulation)   3. Strangulation of intestine   4. Intestinal obstruction due to mesenteric ischemia.   Adynamic type of intestinal obstruction is due to the local paralytic ileus occurring as a result of appendicular inflammation spreading to the adjacent bowel wall. This is the most common type, seen in 1-5% of appendicitis.

Mechanical intestinal obstruction without strangulation occurs as a result of kinking, compression or traction of the small bowel trapped in an appendicular mass or abscess. These can be managed conservatively as the obstruction should resolve with the resolution of the mass. However in some cases, minimal obstruction may persist which can turn into acute intestinal obstruction when a secondary pathology occurs months to years later [3]. The first case of small bowel strangulation caused by appendix was described by Naumon Pembrolizumab in 1963 [4]. Strangulation can be due to the appendix wrapping around the base of a bowel loop, or when inflamed appendix adheres to caecum, small intestine or posterior peritoneum and a part of the bowel herniates through the

gap. This is a rare occurrence with only ten other cases reported in literature. [4–11] Intestinal obstruction occurring as a result Depsipeptide of mesenteric ischemia produced by appendix is the rarest type with a sole case described by Gupta S. in 1969 [7]. The inflamed appendix was adhered to the mesentry near the iliocolic artery causing thrombosis and gangrene of terminal ileum. As to why appendix would adhere to adjacent structures, we have to know that the appendix is a mobile organ with many variations in its normal position. During the initial event of appendicular inflammation, it would get adhered to surrounding structures producing

various pathologies mentioned above. Increased length of appendix logically seems to predispose to such an event. [10] Although the pathology may vary, clinically it is not possible to determine the exact type of intestinal obstruction present. Clinically these patients can be classified into two types: 1) Predominant features of appendicitis with some evidence of intestinal obstruction: In this group of patients, intestinal obstruction occurs during the phase of active appendicitis. Hence the cause is likely to be mechanical or adynamic. However, as mentioned by Assenza, strangulation too may be seen in the acute phase [10]. 2) Patients with Acute intestinal obstruction, on evaluation/laparotomy found to have appendicitis as the cause. In this group, there may or may not be a history of appendicitis.