Partial Caecal Necrosis – a Rare Cause of Right-Sided Inferior Abdominal Pain and Tenderness

Open access

Abstract

Introduction: Non-occlusive caecal infarction is a rare condition that has been described in association with a variety of clinical entities, generally due to a low-flow state, and has been reported to occur in association with chronic heart disease, open-heart surgery, certain drugs, and haemodialysis. The aim of this article is to describe the presentation, diagnosis and management of this unusual clinical problem.

Case presentation: We report on an 84-year-old female with known chronic heart disease presenting with right lower abdominal quadrant pain, tenderness and leukocytosis. Although initial clinical findings were highly suggestive of acute appendicitis, CT revealed marked circumferential wall thickening of the caecum. Intraoperatively, caecal necrosis was confirmed, while the appendix and the remainder of the intestine appeared normal. There was no evidence of major vascular occlusion or embolization. The right hemicolectomy was performed with ileo-transverse anastomosis. Histopatho-logic analysis demonstrated isolated transmural caecal necrosis with marked infiltration of the caecal wall by numerous bacteria and neutrophils as a consequence of nonocclusive ischaemic colitis. The patient recovered completely and was discharged from the hospital on the tenth postoperative day without any surgical complications.

Conclusion: Partial caecal necrosis should be included in the differential diagnosis of acute right lower quadrant pain, especially in elderly patients with chronic heart disease.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • 1. Perko Z Bilan K Vilovic K et al. Partial cecal necrosis treated by laparosopic partial cecal resection. Coll Antropol. 2006 Dec; 30(4): 937–9.

  • 2. Dirican A Bulent U Bassulu N et al. Isolated cecal necrosis mimicking acute appendicitis: a case series. J med Case Reports. 2009: 3: 7443.

  • 3. Flynn TC Rowlands BJ Gilliland M Ward RE Fischer RP. Hypotension induced post-traumatic necrosis of right colon. Am J Surg. 1983; 146: 715–718. doi: 10.1016/0002-9610(83)90325-2.

  • 4. Landrenau RJ Fry WJ. The right colon as target organ of nonocclusive mesenteric ischemia. Arch Surg. 1990; 125: 591–594.

  • 5. Rist CB Watts JC Lucas RJ. Isolated cecum necrosis of the cecum in patients with chronic heart disease. Dis Colon Rectum. 1984; 27: 548–551. doi: 10.1007/BF02555524.

  • 6. Flobert C Cellier C Berger A Ngo A Cuillerier E Landi B Marteau P Cugnenc PH Barbier JP. Right colonic involvement is associated with severe forms of ischemic colitis and occurs frequently in patients with chronic renal failure requiring hemodialy-sis. Am J Gastroenterol. 2000; 95: 195–198. doi: 10.1111/j.1572-0241.2000.01644.x.

  • 7. Boley SJ. Colonic ischemia: 25 years later. Am J Gas-troenterol. 1990; 85: 931–934.

  • 8. Reinus JF Brandt LJ Boley SJ. Ischemic disease of the bowel. Gastroenterol Clin North Am. 1990; 19: 319–343.

  • 9. Bower TC. Ischemic colitis. Surg Clin North Am. 1993; 73: 1037–1053.

  • 10. Wolf EJ. Ischemic disease of the gut. In: Gore RJ Levine MS Laufer I eds. Textbook of gastrointesti nal radiology. Philadelphia Pa: Saunders. 1994; 2694–2706.

  • 11. Hargrove WC Roseto EF Hicks RE Mullen JL. Cecal necrosis after open-heart operation. Ann Thorac Surg. 1978; 25: 71–73.

  • 12. Sloane CE Anderson AA. Cecal infarction: ergot abuse as a possible etiologic factor. Mt Sinai J Med. 1980; 47: 31–33.

  • 13. Kingry RL Hobson RW Muir RW. Cecal necrosis and perforation with systemic chemotherapy. Am Surg. 1973; 39: 129–133.

  • 14. Yamazaki T Shirai Y Tada T et al. Ischemic colitis arising in watershed areas of the colonic blood supply. Surg Today. 1997; 27: 460–462.

  • 15. Netter FH. Atlas of human anatomy. Colacino S ed Summit NJ: Ciba-Geigy. 1989; plates 291–293.

  • 16. Stewart JA Rankin FW. Blood supply of the large intestine. Arch Surg. 1933; 26: 843–891.

  • 17. Slam K Calkins S Cason F. Cecal perforation as an unusual presentation of pancreatic carcinoma. World J Surg Oncol. 2007; 5: 14.

  • 18. Saegesser F Chapuis G Rausis C Tabrizian M Sandblom P. Intestinal distention and colonic ischemia: occlusive complications and perforations of colorectal cancers. A clinical application of Laplace's Law. Chirurgie. 1974; 100: 502–516.

  • 19. Wiesner W Mortelé KJ Glickman JN Ros PR. 'Cecal gangrene': a rare cause of right-sided inferior abdominal quadrant pain fever and leukocytosis. Emerg Radiol. 2002; 9: 292–295.

  • 20. Alpern MB Glazer GM Francis IR. Ischemic or infracted bowel: CT findings. Radiology 1988; 166: 149–152.

  • 21. Federle MP Chun G Jeffrey RB Raylor R. Com puted tomographic findings in bowel infarction. AJR Am J Roentgenol. 1984; 142: 91–95.

  • 22. Mathis JM Zelenik ME Staab EV. CT detection of bowel infarction. Comput Radiol. 1985; 9: 177–179.

  • 23. Simon AM Birnbaum BA Jacobs JE. Isolated infar ction of the cecum: CT findings in two patients. Radiology. 2000; 214: 513–516.

  • 24. Schuler JG Margaret M Hudlin MM. Cecal necro sis: Infrequent variant of ischemic colitis. Dis Colon Rectum. 2000; 43: 708–712. doi: 10.1007/BF02235593.

Search
Journal information
Impact Factor


CiteScore 2017: 0.45

SCImago Journal Rank (SJR) 2018: 0.177

Cited By
Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 163 81 2
PDF Downloads 98 55 1