A Case of Isolated Cecal Necrosis Preoperatively Diagnosed with Perforation of Cecum

Medicina (Kaunas). 2019 Jan 10;55(1):9. doi: 10.3390/medicina55010009.

Abstract

Isolated cecal necrosis (ICN) is a rare condition which is developed under decreased mesenteric perfusion. Only a few dozen cases of ICN have been reported previously. The patient was a 59-year-old male with a previous history of atrial fibrillation. He presented to our emergency room with the chief complaint of lower abdominal pain. Computed tomography imaging revealed a dilated cecum and presence of free air. With a preoperative diagnosis of perforation of the cecum; an urgent surgery was conducted. Intraoperative findings revealed an ischemic change of the cecum and a laparoscopic-assisted ileocecal resection was performed. The pathological findings showed transmural ischemic change on the anti-mesenteric side of the cecum, and the diagnosis of ICN was achieved. Preoperative diagnosis of ICN is difficult because of its non-specific radiological features. In patients with right lower abdominal pain, ICN should be considered as a differential diagnosis especially if the patient has a comorbidity causing hypotension attack.

Keywords: isolated cecal necrosis; laparoscopic-assisted surgery.

Publication types

  • Case Reports

MeSH terms

  • Abdominal Pain / diagnosis
  • Cecum / blood supply
  • Cecum / diagnostic imaging*
  • Cecum / pathology*
  • Cecum / surgery
  • Diagnostic Errors
  • Drainage / adverse effects
  • Emergency Service, Hospital
  • Humans
  • Ileostomy
  • Intestinal Perforation / diagnostic imaging*
  • Intestinal Perforation / etiology
  • Intestinal Perforation / surgery
  • Ischemia / pathology*
  • Laparoscopy
  • Length of Stay
  • Male
  • Middle Aged
  • Necrosis
  • Preoperative Period
  • Tomography, X-Ray Computed