Focal Ischaemia of the Caecum: Another Pitfall in the Management of the Appendicular Syndrome

Abstract

Ischaemic necrosis of the caecum is a rare entity, which has been described in association with vascular occlusive disease and with low flow states. Three patients were admitted to our unit within a 3-year period with an acute, right lower quadrant syndrome which, at operation, proved to be due to focal ischaemia of the caecum, while the appendix and the remainder of the intestine appeared normal. In 1 patient, a caecal artery was occluded by organized thrombus containing cholesterol crystals. A right hemicolectomy was carried out in 2 patients who made an uneventful recovery. The third patient had a caecectomy and had to be reoperated for extension of the bowel necrosis. Focal ischaemia of the caecum should be considered in the differential diagnosis and management of the appendicular syndrome.