Isolated cecal necrosis mimicking acute appendicitis: a case series

Area of Science:

• Gastroenterology
• Vascular Surgery
• Abdominal Imaging

Background:

• Isolated cecal necrosis is a rare cause of right lower quadrant pain, often mistaken for acute appendicitis.
• This condition typically results from a low-flow state, such as shock.
• Limited data exists on postoperative ischemic necrosis following treatment for isolated cecal necrosis.

Purpose of the Study:

• To report four cases of isolated cecal necrosis mimicking acute appendicitis.
• To highlight the importance of considering isolated cecal necrosis in the differential diagnosis of right lower quadrant pain.
• To discuss the prognosis and management of this condition.

Main Methods:

• Retrospective review of four cases diagnosed with isolated cecal necrosis over a four-year period.
• Analysis of patient demographics, clinical presentation, medical history, surgical procedures, and follow-up outcomes.
• Surgical interventions included right hemicolectomy with anastomosis or cecal resection with ileocolostomy.

Main Results:

• Four patients (mean age 59) presented with right lower quadrant abdominal pain, nausea, and vomiting.
• Three patients had end-stage renal failure requiring hemodialysis; one had chronic obstructive pulmonary disease.
• All patients underwent surgical intervention and healed without complications, with no recurrence of ischemia during a median follow-up of 24.5 months.

Conclusions:

• Isolated cecal infarction should be considered in the differential diagnosis of acute right lower quadrant abdominal pain, particularly in patients on chronic hemodialysis.
• Early diagnosis and surgical treatment of isolated cecal necrosis are associated with a favorable prognosis.
• Compared to diffuse intestinal ischemic disease, isolated cecal necrosis has lower morbidity, mortality, and recurrence rates.