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  Background : Mechanical obstruction is the most common surgical disease of the small intestine , which can be potentially fatal . However appendicitis is very rare cause of intestinal obstruction and is usually . In rare cases of appendicitis, symptoms of small intestine obstruction can be more predominant than the appendicitis symptoms . This may lead to delayed diagnosis of appendicitis and further complications such as intestinal strangulation appendix perforation .   Methods : A 20 -year-old male patient , presented with bowel obstruction symptoms since 5-day ago. There was all mechanical bowel obstruction symptoms include frequent nausea and vomiting , severe abdominal distention , fever and inability to gas or stool pass there. Serial abdominal X-rays showed multiple air -fluid levels and CT scan was demonstrating obstruction at terminal ileum and cecum . In Laparotomy with midline incision , there was severe dilation of the small intestine caused by pressure effect on bowel wall due to gangrenous appendicitis after appendectomy , all symptoms was relieved   Conclusion : Early diagnosis and intervention is very important in strangulation of bowel. Whenever features of intestinal obstruction predominate, we should think about appendicitis as a rare cause of obstruction. Especially in cases with elevation in markers of inflammation.