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Acute necrotizing colitis with cecal perforation in a patient with autosomal dominant polycystic kidney disease: a
1Center of Excellence in Trauma and Accidents, King Abdulaziz University, Jeddah 21589, Saudi Arabia.
Insights
Autosomal dominant polycystic kidney disease (ADPKD) patients, particularly those on dialysis, face a rare risk of necrotizing colitis and colonic perforation. Early recognition of abdominal symptoms is crucial for timely intervention in these high-risk individuals.
Area of Science:
- Nephrology
- Gastroenterology
- Surgical Pathology
Background:
- Autosomal dominant polycystic kidney disease (ADPKD) is a prevalent genetic disorder with diverse systemic effects.
- While renal and vascular complications are recognized, gastrointestinal manifestations are infrequently documented.
Observation:
- A 50-year-old female ADPKD patient on dialysis presented with sepsis and abdominal pain.
- Imaging revealed free intraperitoneal air, indicative of a perforated viscus.
Findings:
- Exploratory laparotomy confirmed acute necrotizing colitis with cecal perforation.
- Histopathology verified transmural necrosis and ulceration, necessitating ileocecal resection.
Implications:
- This case highlights an unusual, life-threatening gastrointestinal complication in ADPKD patients.
- Emphasizes the need for prompt diagnosis and surgical management of acute abdominal conditions in ADPKD individuals, especially those on dialysis.
Abstract:
Autosomal dominant polycystic kidney disease (ADPKD) is a common hereditary disorder with both renal and extrarenal manifestations. While hepatic cysts and intracranial aneurysms are well-known complications, gastrointestinal involvement is rarely reported. Colonic perforation and necrotizing colitis in ADPKD patients, especially those undergoing dialysis, represent an unusual and serious clinical scenario. We report a rare case of acute necrotizing colitis with cecal perforation in a 50-year-old female with a known history of ADPKD, hypertension, and end-stage renal disease on dialysis. The patient presented with vague abdominal pain, systemic signs of sepsis, and was found to have free intraperitoneal air. Exploratory laparotomy revealed cecal perforation with necrotic segments, prompting ileocecal resection. Histopathological examination confirmed acute necrotizing colitis with two perforated ulcers. The case underscores the importance of early recognition and intervention in ADPKD patients presenting with acute abdomen, highlighting an uncommon but life-threatening complication.
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