Abstract
IntroductionSpontaneous non-occlusive ischemic colitis involving the cecum alone (isolated cecal necrosis) is a rare condition that is generally due to a low-flow state: shock. It presents with right lower quadrant abdominal pain and may resemble acute appendicitis. Little is known about postoperative ischemic necrosis of the remaining colon after surgical treatment of isolated cecal necrosis. We report four cases of isolated cecal necrosis mimicking acute appendicitis seen at our institution within a 4-year period.Case presentationThe patients were two men and two women with a mean age at diagnosis of 59 years (range 46-68). The patients were of Turkish ethnic origin. All patients presented to the emergency room with acute abdominal pain and had symptoms of nausea and vomiting. The medical histories for three of the patients revealed end-stage renal failure requiring hemodialysis. The other patient had chronic obstructive pulmonary disease. Right hemicolectomy with anastomosis was performed in three patients and cecal resection with ileocolostomy was performed in the remaining one patient. All of the patients healed without complications. Median follow-up of patients was 24.5 (range: 17-37) months. There was no recurrence of ischemia in the remaining colon during the follow-up period of the patients.ConclusionIsolated cecal infarction should be included in the differential diagnosis of acute pain in the right lower quadrant of the abdomen, especially in those patients on chronic hemodialysis. While diffuse ischemic disease of the intestine has high morbidity, mortality and recurrence rates, patients with isolated cecal necrosis have a good prognosis with early diagnosis and surgical treatment compared to those with diffuse ischemic disease.
Highlights
Spontaneous non-occlusive ischemic colitis involving the cecum alone is a rare condition that is generally due to a low-flow state: shock
Little is known about postoperative ischemic necrosis of the remaining colon after surgical treatment of isolated cecal necrosis
We report four cases of isolated cecal necrosis mimicking acute appendicitis seen at our institution within a 4-year period
Summary
Ischemic colitis usually results from atherosclerosis and low blood flow. Acute colonic ischemia is a common cause of colitis in the elderly, in whom colonic ischemia is a cause of morbidity. Cecal infarction presents with right lower quadrant pain, and may resemble acute appendicitis As this variant of ischemic colitis is less common, it may not be considered in the differential diagnosis of right lower quadrant pain. We report four patients with isolated cecal necrosis mimicking acute appendicitis seen at our institution within a 4-year period. Case presentation This series is a retrospective analysis of isolated cecal necrosis cases diagnosed and treated at Inonu University Turgut Ozal Medical Center between July 2004 and June 2008. After a detailed examination of the medical records, four patients with confirmed diagnoses of isolated cecal necrosis were identified Data regarding their age, sex, clinical presentation, comorbid diseases, imaging findings, treatment modality, and follow-up were reviewed. There were no postoperative complications, and the median follow-up period was 24.5 (range: 17-37) months
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call