The first three cases of small bowel obstruction due to appendicitis were described in 1901 by Hotchkiss . Since then, several authors have published other cases, which have made it possible to classify the occlusions of the small bowel in relation to an appendicitis in several groups. Thus, according to Soo and Tsegha  and Makama et al. , we distinguish the paralytic ileus, mesenteric ischemia, mechanical occlusions without strangulation, and finally the mechanical occlusion by strangulation, and the first case was described by Naumov  in 1963. The term appendicular tourniquet means the loop resulting from the adhesion of the tip of the appendix to its base in the manner of a tourniquet. This is a rare pathological situation. In 2016, Chowdary  identified only 16 published cases. Adhesion of the appendicular tip is thought to be related to the inflammatory process and peritoneal reaction in response to appendicitis . The diagnosis is almost always intraoperative. Indeed, in most cases, the occlusive syndrome dominates the clinical situation, thus masking the signs of appendicitis. This was also the case of our patient. The occlusion in this case is by internal hernia of the small intestine in the appendicular loop and constitutes the circumstance of discovery. The initial hypothesis in our patient was tumor occlusion of the transverse colon. The importance of distension explains the impression of extrinsic compression that was visualized at the gastroscopy and misplaced our diagnosis even more. The abdominal computed tomography would have been a better help. Indeed, it is the most appropriate examination to explore the occlusive syndrome  because it specifies the mechanism, the seat, and very often the cause. It would probably have allowed preoperative diagnosis and would have made it possible to avoid exploratory laparoscopy, carried out here for diagnostic purposes, in the hypothesis of the colonic tumor. However, computed tomography can be unavailable, especially into resource-limited hospitals in low-income countries such as ours. Waiting for that imaging can then lead to complications that are more difficult to treat like perforation followed by peritonitis. In our case, there was no peritonitis because the perforation has been blocked by the appendicular knot. According to Sebastian-Valverde et al. , a laparoscopic approach in the management of small bowel obstruction is feasible, effective, and safe. It has been clinically proven to be an advantage over an open approach . It is associated with better postoperative outcomes, lower morbidity, an earlier onset of oral intake, and a shorter length of hospital stay . However, it requires a specific skill set, it may not be appropriate in all patients , and patient selection is the strongest key factor for having success . Conversion to median laparotomy is becoming increasingly rare in countries with high technical equipment and the list of conversion patterns is becoming limited . The best exploration of the peritoneal cavity is no longer a motive for conversion. However, the fragility of the distended loops and the risk of iatrogenic perforation were the main reason that led to the conversion in our case. The incision in the right iliac fossa is not suitable to treat the appendicular node. As in our case, all authors used medial laparotomy as providing a better day to treat occlusion and its cause. Treatment always consists on an appendectomy associated or not with intestinal resection—suture as a function of the viability of the small intestine [1,2,3,4, 7,8,9].