Abstract
Appendico-ileal knotting is an extremely rare complication of acute appendicitis, leading to obstruction when the inflammed appendiceal shaft wraps around the adjacent ileal segment and its mesentery. Diagnosis requires high clinical suspicion and urgent surgical exploration. Based on the extent of appendiceal base gangrene, en bloc ileal resection with appendectomy or right hemicolectomy is the mainstay of treatment to prevent systemic bacterial or toxin spread and contamination.