Isolated caecal necrosis—a case study

Abstract

A patient with right iliac fossa pain underwent CT angiography which demonstrated isolated caecal necrosis with associated superior mesenteric artery (SMA) stenosis. This was supported by colonoscopic findings and histopathological analysis. Isolated caecal necrosis is a rare presentation of ischaemic colitis.. Clinical and imaging findings of ischaemic colitis may mimic other pathologies. To improve diagnostic accuracy both referrers and radiologists should be aware of risk factors associated with ischaemic colitis. Isolated bowel wall thickening and pneumatosis of a colonic segment on CT are suggestive of focal bowel ischaemia, in the right clinical context.

Isolated cecal necrosis: Report of two cases

“…1,5 The most important factor for developing ICN is a presence of the comorbidity, which causes decreased mesenteric perfusion. 1,4 ICN is divided into two groups according to the presence of comorbidities:…”

“…In some other cases, it can be attributed to drugs such as thiopentone, cocaine, vincristine, prednisolone, ergot, or glypressin. 1,3,4 Type II (or secondary): decrease in mesenteric flow is identifiable, such as following cardiopulmonary bypass or resuscitation and hypotension in patients undergoing hemodialysis for renal failure. 1,4 Our two patients could be classified as Type I because they did not have an apparent episode of systemic hypotension.…”

“…These arteries often arise from the vascular arcade between the ileal branch and colic branch of the ileocolic artery, while in the others, these arteries arise directly from the ileal or colic branch. 2,4 If this arcade is absent, the cecal blood supply is considered deficient. In addition, the vasa recta supplying the cecum are the longest because this segment of bowel has the widest diameter, which makes the cecum vulnerable to ischemia 4 Cecal necrosis on acute colonic pseudo-obstruction, known as Ogilvie syndrome, is a distinct entity.…”

“…2,4 If this arcade is absent, the cecal blood supply is considered deficient. In addition, the vasa recta supplying the cecum are the longest because this segment of bowel has the widest diameter, which makes the cecum vulnerable to ischemia 4 Cecal necrosis on acute colonic pseudo-obstruction, known as Ogilvie syndrome, is a distinct entity. As the cecum and ascending colon dilate and the luminal diameter increases, wall tension in the colonic mucosa increases proportionately.…”

“…The diagnosis of ICN is mostly established on intraoperative findings. 3,4 We report two cases of isolated cecal necrosis, which were preoperatively diagnosed, in two female patients with a common previous history of hypertension and renal failure.…”