Partial caecal necrosis
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Hellenic Journal of Surgery (2016) 88:1, 69-71
Partial Caecal Necrosis Oktay Yener, Mehmet Zeki Buldanlı, Özgür Ekinci, Ercüment Tombalak
Abstract 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. We report on an 80-year-old female with known chronic heart disease and chronic renal failure presenting with right lower abdominal quadrant pain, tenderness and leukocytosis. Intraoperatively, caecal necrosis was confirmed, while the appendix and the remainder of the intestine appeared normal. Ileocaecal resection and anastomosis was performed. Histopathologic analysis demonstrated isolated transmural caecal necrosis as a consequence of nonocclusive ischaemic colitis. The patient made a complete recovery and was discharged from the hospital on the fifth postoperative day without any surgical complications. Key words: Caecum; necrosis
Introduction
Case presentation
Partial caecal necrosis should be kept in mind in the differential diagnosis of acute right lower quadrant pain, especially in elderly patients with chronic renal failure and chronic heart disease. Acute colonic ischaemia is a common cause of colitis in the elderly population [1]. Ischaemic colitis usually results from atherosclerosis and low blood flow. Acute colonic ischaemia is a common cause of colitis in the elderly, in whom colonic ischaemia is a cause of morbidity. However, spontaneous isolated non-occlusive ischaemic necrosis of the caecum is a rare entity, with only a few cases reported in the literature. Caecal infarction presents with right lower quadrant pain and may therefore resemble acute appendicitis [2]. Given the possibility of caecal perforation, an early diagnosis and surgical treatment are very important factors in such cases. Herein, we report the case of a patient with partial caecal necrosis who was admitted to our faculty with right-side inferior abdominal pain and local tenderness. The purpose of this article is to describe the presentation and management of this unusual clinical problem [3].
An 80-year-old female patient presented to the emergency department complaining of abdominal pain associated with nausea and fatigue. She had a 2-day history of abdominal discomfort with diffuse abdominal pain which was localized in the lower right quadrant. On physical examination, she had right lower quadrant pain and tenderness. Her abdomen was distended and painful on palpation, with guarding and localized rebound tenderness in the right lower quadrant. Bowel sounds were diminished. No hepatosplenomegaly, ascites, or palpable masses were detected. Laboratory analysis included a complete blood count (CBC) and biochemical parameters demonstrated an elevated level of lactate dehydrogenase 409U/L. There were no specific signs in the patient’s preoperative chest and abdominal X-rays. An ultrasound and abdo
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