Presentation
Emergency department referral for abdominal pain and raised inflammatory markers
Patient Data
Dilated thin-walled cecum with pneumatosis, measuring 9 cms in diameter.
Twisted mesentery at transition point, best seen on coronal reformats. Proximal ileal dilatation, diameter 5 cms. Distal colon non-distended.
Moderate ascites.
No portal venous gas.
Incidental Bartholin's cyst.
Case Discussion
Classic features of cecal volvulus complicated by ischemic cecum. Urgent surgery performed in view of the risk of perforation.
Pathology:
Macroscopic Description: The cecum is markedly dilated and has dusky serosa and red grey mucosa largely covered in fibrinous exudate. There is partial loss of mucosal folds. This abnormal area is located 70 mm from the distal margin and 45 mm from the proximal margin. No sites of perforation are identified. On the mesenteric surface there are two areas where the serosa shows particularly dusky/purple discolouration, 20-26 mm in size.
Microscopic Description: The cecal wall has an inflamed degenerate appearance with necrosis of the mucosa. There is an associated moderate neutrophilic inflammatory infiltrate involving the full thickness of the wall. The muscularis propria appears pale and fragmented, particularly the inner circular layer. There is moderate edema and prominent congestion. The mesenteric vessels are unremarkable.
DIAGNOSTIC SUMMARY: Cecal volvulus, right hemicolectomy specimen: Moderately severe acute ischemic necrosis, consistent with clinical history of cecal volvulus.
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