Abstract
Isolated ischemic necrosis of the cecum is an infrequently described entity. We report three cases seen at our institution within a three-year period. All three patients had been hospitalized for congestive heart failure in the past, but none was in failure at the time of the most recent hospitalization. All three patients prsented with clinical and laboratory findings consistent with acute appendicitis. At surgery the cecum was ischemic in each case, while the appendix and the remainder of the intestine appeared normal. There was no evidence of major vascular occlusion or embolization at the time of original operation. We propose that the cecum, like the splenic flexure, is a “watershed area”, with poor blood supply relative to that of the adjacent intestine. While cecal ischemia has been described in association with a variety of clinical entities, we propose a newly recognized association with poor myocardial function. In such patients, isolated ischemic necrosis of the cecum should be considered in the differential diagnosis of right lower quadrant pain.
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References
Hakami M. Localized gangrene of the cecum and acute articular rheumatic fever. Am J Proctol 1976;27:30–4.
Ikard RW. Neutropenic typhlitis in adults. Arch Surg 1981;116:943–5.
Dworkin B, Winawer SJ, Lightdale CJ. Typhlitis: report of a case with long-term survival and a review of the recent literature. Dig Dis Sci 1981;26:1032–7.
Hargrove WC, Rosato EF, Hicks RE, Mullen JL. Cecal necrosis after open-heart operation. Ann Thorac Surg 1978;25:71–3.
Sloane CE, Anderson AA. Cecal infarction: ergot abuse as a possible etiologic factor. Mt Sinai J Med 1980;47:31–3.
Uys CJ, Wright DJ, Botha JBC, Keeton GR. Clinicopathological conference: a case of dyspepsia and diarrhea. S Afr Med J 1980;57:452–7.
Gerlock AJ, Muhletaler CA, Berger JL, Halter SA, O'Leary JP, Avant GR. Infarction after embolization of the ileocolic artery. Cardiovasc Intervent Radiol 1981;4:202–5.
Carnevale NJ, Delaney HM. Cholesterol embolization to the cecum with bowel infarction. Arch Surg 1973;106:94–6.
Netter FH. The Ciba collection of medical illustrations Volume 3 Digestive System part II Lower Digestive Tract. Ciba Pharmaceutical Company, 1962:66–8.
Gilbert RF. Cecal infarction secondary to a distal obstructing fecaloma: association with drug abuse. South Med J 1980;73:1296–7.
Ferrer MI, Bradley SE, Wheeler HO, Enson Y, Preisig R, Harvey RM. The effect of digoxin in the splanchnic circulation in ventricular failure. Circulation 1965;32:524–37.
Gazes PC, Holmes CR, Moseley V, Pratt-Thomas HR. Acute hemorrhage and necrosis of the intestines associated with digitalization. Circulation 1961;23:358–64.
Wilson R, Qualheim RE. A form of acute hemorrhagic enterocolitis afflicting chronically ill individuals. Gastroenterology 1954;27:431–44.
Ming SC. Hemorrhagic necrosis of the gastrointestinal tract and its relation to cardiovascular status. Circulation 1965;32:332–41.
Bhagwat AG, Hawk WA. Terminal hemorrhagic necrotizing enteropathy (THNE). Am J Gastroenterol 1966;45:163–88.
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Rist, C.B., Watts, J.C. & Lucas, R.J. Isolated ischemic necrosis of the cecum in patients with chronic heart disease. Dis Colon Rectum 27, 548–551 (1984). https://doi.org/10.1007/BF02555524
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DOI: https://doi.org/10.1007/BF02555524