Isolated cecal necrosis: our surgical experience and a review of the literature

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 black cecum: diagnostic challenges and conservative management

A 51-year-old man with type 1 diabetes mellitus and end-stage chronic kidney disease on hemodialysis presented with 12 hours of lower right quadrant abdominal pain and bloodless diarrhea. Examination showed tenderness without guarding. Blood tests showed leukocytosis (12200/microl) and elevated C-reactive protein (190 mg/L). Abdominal CT showed ascending colon thickening (~10 cm), mesenteric fat densification, and small locoregional ganglia, without signs of arterial/venous obstruction. Given the diagnostic doubt, colonoscopy was performed and revealed the cecum mucosa and ileocecal valve with a black color, with superficial ulceration of the proximal limit and sharp transition to normal mucosa. Biopsies of the cecum confirmed severe ischemic colitis with necrosis. Due to the absence of complications and high surgical risk, the patient was treated conservatively with fluids and antibiotics, resulting in a favorable outcome and hospital discharge.

Isolated Cecal Necrosis Mimicking a Colonic Mass

Isolated cecal necrosis (ICN) is a rare form of ischemic colitis that can mimic conditions such as appendicitis, malignancy, or diverticulitis. Most cases of ICN have been identified in patients with significant comorbidities that increase risk of vascular disease. We present a case of ICN mimicking a mass lesion in an elderly patient with few comorbid conditions. Although computed tomography was concerning for colonic mass, diagnostic colonoscopy revealed ischemic colon. The patient underwent right hemicolectomy, and pathology confirmed ICN. It is important to recognize conditions ICN can mimic, understand ICN can present without acute abdomen, and consider ICN in the differential diagnosis even in relatively healthy patients without a history of vascular disease.

Isolated cecal necrosis: Report of two cases

Isolated cecal necrosis is a rare variant of ischemic colitis. Diagnosis is difficult because of nonspecific clinical and radiological findings. It especially affects patients with comorbidities affecting mesenteric perfusion.

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.