A Rare Case of Vasculitis Patched Necrosis of Cecum due to Behçet's Disease

Isolated Cecal Necrosis as a Cause of Acute Abdomen

Background/Objectives: Isolated cecum necrosis (ICN) is a rare disease and there are few reports on it in the literature. We retrospectively analyzed the patients with acute abdomen who had ICN, in terms of etiology, demographic findings, surgery, and prognosis to determine the best treatment approach. Methods: Seven patients with per-operative diagnosis of isolated cecal necrosis were included in the study. Age, gender, comorbidities, symptoms, laboratory data, imaging modalities, time from symptoms to surgery, surgical procedure, hospital stay, morbidity, and mortality were retrospectively analyzed. Results: The median age of the patients and the F/M ratio were 61 years and 2/5, respectively. The most common comorbidity was chronic renal failure, followed by hypertension, diabetes mellitus, and coronary artery disease. The median time from symptom onset to surgery was 1 day. The ileocolic anastomosis was performed in 4 patients and terminal ileostomy in three patients. The morbidity and mortality rates were 28.5% and 14.3%, respectively. The median length of hospital stay was 12 days. Conclusions: ICN should be suspected in elderly patients with comorbidities presenting to the emergency department with an acute abdomen. Computed tomography is an important diagnostic tool. Diagnostic laparoscopy is a good option for definitive diagnosis and end ileostomy is better than anastomosis in patients with bleeding tendency or hypotensive patients with chronic renal failure on dialysis, coronary artery disease, and in the presence of purulent peritonitis to reduce morbidity and mortality.

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

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.