Introduction: Blind loop syndrome (BLS) occurs when there is intestinal content stasis and consequent bacterial hyperproliferation in a segment of the bowel no longer in continuity with intestinal flow.
Case Description/Methods: A 26-year-old woman presented with acute abdominal pain. Two years prior, she underwent a laparoscopic-to-open ileocecectomy with side-to-side ileocolonic anastomosis, appendectomy, and cholecystectomy for perforated appendicitis with phlegmon. Pathology showed terminal ileal serositis, mural abscess, and fistula formation. She had no prior colonoscopy. Since her procedure, she had 4 to 6 loose, non-bloody, greasy stools daily. Four months prior, she developed abdominal pain, nausea, anorexia, without changes in baseline stool pattern. She was diagnosed with Campylobacter enteritis and was treated with ciprofloxacin. CT abdomen showed mural thickening and inflammatory stranding in the blind-limb of the ileum (Figure A). This admission, she described acute, crampy right-lower-quadrant abdominal pain with baseline diarrhea and no enticing factors. Labs notable for leukocytosis (22/L) and elevated CRP (43.3 mg/L). Repeat CT abdomen showed increased inflammation around the ileum blind-limb with a contained perforation (Figure B) which was confirmed on MRI (Figure C). The recurrent ileitis localized solely to the blind-loop portion of the bowel was most consistent with BLS. She was treated with antibiotics and underwent a successful revision of her anastomosis with resection of the blind ending loop of the ileum.
Discussion: BLS remains a diagnostic challenge requiring a high level of suspicion given its rarity and lack of specific diagnostic modalities to identify this disease. Our patient’s initial presentation of perforated appendicitis with serositis and fistulizing disease was suggestive of Crohn’s Disease, which is also known to recurred at surgical anastomosis sites. However, repeat imaging studies showing recurrent inflammation solely around the blind loop and in absence of other areas of inflammation within the bowel or systemically is most suggestive of BLS. This case highlights the importance of maintaining BLS on the differential for focal intestinal inflammation in the setting of altered bowel anatomy.
Figure: CT abdomen showing mural thickening and inflammation around the ileal blind-loop (A) and contained perforation (B). MRI confirming contained perforation (C)
Disclosures: Caroline Matchett indicated no relevant financial relationships. Xiao Jing Wang indicated no relevant financial relationships.
Caroline Matchett, MD, Xiao Jing Wang, MD. P3026 - A Case of Blind Loop Syndrome: A Rare Mimicker, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.