Focal cecal ischemia

Case contributed by Dr Derek Smith

Presentation

Acute presentation with right iliac fossa / groin pain and tenderness. Elevated inflammatory markers. Clinical concern about potential for incarcerated hernia.

Patient Data

Age: 80 years
Gender: Male
CT

Thickening of the wall of the cecal pole, proximal to the ileocecal valve, with mural edema, over approximately 5 cm. Associated appendix engorgement / acute inflammatory change with minor local fatty stranding. No perforation or bowel obstruction. Remainder of unprepared bowel unremarkable. No hernia.

Cholelithiasis and left adrenal adenoma (stable from previous scan). Otherwise normal solid abdominal viscera. No free fluid, collection, or significant nodal enlargement.

Small right lung base nodule.

Normal skeleton.

Case Discussion

This scan was reported as a cecal mass with associated appendicitis.

The patient proceeded to undergo a right hemicolectomy.

PATHOLOGY was returned showing extensive mucosal necrosis with surface exudate and transmural inflammation. This is consistent with an ischemic insult with evidence of reperfusion injury. No dysplasia or malignancy in the sample. Normal sampled mesocolic vessels. Also, submucosal fatty deposits in the appendix but no acute appendicitis. Normal terminal ileum and ascending colon.

DIAGNOSIS ischemic right colon, no evidence of malignancy

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