Abstract
PURPOSE: Spontaneous nonocclusive ischemic colitis involving only the right colon is an infrequent occurrence. Because this problem is less recognized than its counterpart involving the left colon, the correct diagnosis may not be considered. The purpose of this article was to describe the presentation and management of this unusual clinical problem. METHODS: Five cases of nonocclusive ischemic cecal necrosis are described. Four of the patients presented with right-sided abdominal pain, tenderness, and leukocytosis. The preoperative diagnosis was incorrect in all patients, although cecal necrosis was considered in one. Two patients were thought to have appendicitis, two were thought to have carcinoma, and one was thought to have a perforated viscus. Each patient underwent a right hemicolectomy and four survived. RESULTS: Each of the patients had ischemic cecal necrosis without evidence of emboli or vasculitis. Although cecal gangrene may occur after systemic hypotension, no such event preceded these patients' presentation. We believe that the patients we treated had a form of nonocclusive ischemic colitis, which occasionally affects only the right colon. CONCLUSION: Ischemic necrosis of the cecum is an infrequent variant of ischemic colitis that should be considered in the differential diagnosis of the elderly patient presenting with right lower quadrant pain.
Similar content being viewed by others
References
Boley SJ. Colonic ischemia—25 years later. Am J Gastroenterol 1990;85:931–4.
Sakai L, Keltner R, Kaminski D. Spontaneous and shock-associated ischemic colitis. Am J Surg 1980;140:755–60.
Ludwig KA, Quebbeman EJ, Bergstein JM, Wallace JR, Wittman DH, Aprahamian C. Shock-associated right colon ischemia and necrosis. J Trauma 1995;39:1171–4.
Kaminski DL, Keltner RM, Willman VL. Ischemic colitis. Arch Surg 1973;106:558–63.
Landrenau RJ, Fry WJ. The right colon as a target organ of nonocclusive mesenteric ischemia. Arch Surg 1990;125:591–4.
Longo WE, Ballantyne GH, Gusberg RJ. Ischemic colitis: patterns and prognosis. Dis Colon Rectum 1992;35:726–30.
Guttormson NL, Bubrick MP. Mortality from ischemic colitis. Dis Colon Rectum 1989;32:469–72.
Saegesser F, Loosli H, Robinson JW, Roenspies U. Ischemic diseases of the large intestine. Int Surg 1981;66:103–17.
Marston A, Pheils MT, Thomas ML, Morson BC. Ischaemic colitis. Gut 1966;7:1–15.
Barcewicz PA, Welch JP. Ischemic colitis: current trends. Conn Med 1979;43:695–8.
Marcuson RW, Farman JA. Ischaemic disease of the colon. Proc R Soc Med 1971;64:1080–3.
Friedell ML. Cecal necrosis in the dialysis-dependent patient. Am Surg 1985;51:621–2.
Jablonski M, Putzki H, Heymann H. Necrosis of the ascending colon in chronic hemodialysis patients: report of three cases. Dis Colon Rectum 1987;30:623–5.
Flynn T, Rowlands B, Gilliland M, Ward R, Fischer R. Hypotension induced post-traumatic necrosis of the right colon. Am J Surg 1983;146:715–8.
Rist CB, Watts JC, Lucas RJ. Isolated ischemic necrosis of the cecum in patients with chronic heart disease. Dis Colon Rectum 1984;27:548–51.
Abel ME, Russell TR. Ischemic colitis: comparison of surgical and nonoperative management. Dis Colon Rectum 1983;26:113–5.
Brandt LJ, Katz HJ, Wolf EL, Mitsudo S, Boley SJ. Simulation of colonic carcinoma by ischemia. Gastroenterology 1985;88:1137–42.
Jeck T, Sulser H, Heer M. Local ischemia causes carcinoma-like changes of the rectum. Dis Colon Rectum 1996;39:1026–30.
Rodríguez-Sanjuán JC, Naranjo A. Cecal ischemia mimicking carcinoma [letter]. Dis Colon Rectum 1997;40:867–8.
Schuler J, Shortsleeve M, Goldenson R, Perez-Rossello J, Perlmutter R, Thorson A. Is there a role for abdominal computed tomographic scans in appendicitis? Arch Surg 1998;133:373–6.
Gandhi SK, Hanson MM, Vernava AM, Kaminski DL, Longo WE. Ischemic colitis. Dis Colon Rectum 1996;39:88–100.
Bradbury A, Brittenden J, McBride K, Ruckley C. Mesenteric ischaemia: a multidisciplinary approach. Br J Surg. 1995;82:1446–59.
Author information
Authors and Affiliations
About this article
Cite this article
Schuler, J.G., Hudlin, M.M. Cecal necrosis: Infrequent variant of ischemic colitis. Dis Colon Rectum 43, 708–712 (2000). https://doi.org/10.1007/BF02235593
Issue Date:
DOI: https://doi.org/10.1007/BF02235593