Partial Infarction of Cecal Wall Presenting as Acute Appendicitis

Abstract

Acute appendicitis is one of the most common causes of acute abdomen in children and young adults, with differential diagnoses involving several surgical, medical as well as obstetrics and gynecology (OB-GYN)related conditions. Cecal wall necrosis is not usually included in the differential diagnosis of acute appendicitis, mainly because of the rare nature of the condition and the relatively low level of awareness among surgeons. We present a case of isolated cecal wall necrosis presenting as acute appendicitis. It involves a 42-year-old male patient who presented to the emergency department (ED) of our hospital with abdominal pain for three days. The pain was felt over the right lower quadrant and was associated with nausea, vomiting, and anorexia. The case was diagnosed as acute appendicitis and the patient was taken to the operating room (OR). Upon entering the abdomen, necrosis of the anterolateral wall of the cecum was discovered with a normal appendix. Resection of the cecum was performed, followed by ileocolic anastomosis. The patient was discharged in good condition after 10 days of hospital stay. This case report highlights the importance of considering cecal wall necrosis in patients presenting with right lower quadrant abdominal pain who display atypical signs and symptoms of appendicitis; we also wish to promote awareness among surgeons about this rare condition.