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

• Published in: Medicina (Kaunas, Lithuania) Lithuania), 2019-01, Vol.55 (1), p.9
• Main Authors: Kohga, Atsushi, Yajima, Kiyoshige, Okumura, Takuya, Yamashita, Kimihiro, Isogaki, Jun, Suzuki, Kenji, Komiyama, Akira, Kawabe, Akihiro
• Format: Article
• Language: English
• Subjects: Case Report; isolated cecal necrosis; laparoscopic-assisted surgery
• ISSN: 1648-9144; 1010-660X; 1648-9144; 1010-660X
• DOI: 10.3390/medicina55010009

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.