Isolated cecal necrosis mimicking complicated colonic neoplasm

Abstract

Introduction: Isolated cecal necrosis (ICN) is an atypical manifestation of ischemic colitis that can mimic various abdominal pathologies. Its occurrence is associated with risk factors such as diabetes mellitus, coronary artery disease, and hemodialysis. Preoperative diagnosis is challenging due to the nonspecific nature of clinical and radiological findings. Clinical Case: We present the case of a 70-year-old female patient with a history of hypertension, diabetes mellitus, and chronic renal failure on hemodialysis, who consulted for abdominal pain in the right lower quadrant, accompanied by nausea, vomiting, and diarrhea. A computed tomography scan revealed mural thickening of the cecum, pneumatosis of the wall, and signs of hypoperfusion. Surgical management was decided upon through laparoscopy, where segmental necrosis of the cecum was confirmed, with no involvement of other areas. A segmental cecal resection and prophylactic appendectomy were performed. Histopathological examination confirmed the diagnosis of ischemic colitis. The patient had a favorable outcome. Conclusion: ICN is a rare condition that should be included in the differential diagnosis of patients with abdominal pain, especially in older women with vascular or metabolic comorbidities. Early recognition of risk factors, contrast-enhanced computed tomography, and timely surgical exploration, ideally via a laparoscopic approach, are essential for establishing the diagnosis and providing optimal treatment, which should be individualized based on the extent of necrosis and the patient’s condition.