Isolated Cecal Necrosis Mimicking a Perforated Peptic Ulcer: A Case Report

Abstract

Isolated cecal necrosis is a rare surgical emergency. In most cases the clinical picture resembles an acute appendicitis, usually occurring in elderly patients who have associated diseases. We believe that this is the first published case of isolated cecal gangrene, mimicking a perforated ulcer. A previously healthy 82-year-old male presented with abdominal pain, stabbing in nature, and of 12-hours duration. The clinical signs and symptoms were consistent with a perforated peptic ulcer. A plain abdominal X-ray disclosed a significant pneumoperitoneum. An emergency laparotomy released a gas under pressure revealing an isolated gangrenous cecum. Perforation of the cecum and fecal soiling were not present. A right hemicolectomy was performed. An intra-operative hemodynamic instability precluded primary anastomosis and a double barrel ileocolostomy was created. The patient was discharged in good health on the 8th postoperative day. This paper presents an original case of isolated cecal necrosis. A high index of suspicion should be maintained and the condition promptly addressed. Any delay is associated with high mortality rate. The procedure of choice is ileocecal resection or right hemicolectomy. The intestinal continuity should be restored through a primary anastomosis unless stump blood supply or peritoneal contamination, or patient’s overall condition are specific concerns.