The Unusual Cecum

Abstract

History A 90-year-old woman was admitted to Montefiore Medical Center with a two-day history of severe right lower quadrant pain associated with nausea and vomiting. The patient's past medical record indicated a history of severe peripheral arterial disease, including bypass surgery, previous myocardial infarction, and right cerebral infarction. Physical examination showed right lower quadrant tenderness without peritoneal signs and a heme-positive stool. A blood examination revealed a hemoglobin level of 11.0 g/dL with hypochromic, microcytic indices. A barium enema study was obtained (Figs 1 and 2); the abnormalities demonstrated involved the cecum and ascending colon and will be described subsequently. Diagnosis Ischemic colitis involving the cecum and ascending colon. Figure 2 (spot film) demonstrates (1) a mass on the lateral surface of the ascending colon just above the ileocecal valve (black arrow); (2) edematous folds in the cecum (black arrowheads); (3) submucosal polypoid masses on the lateral wall of the