American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2016, 4(10), 349-353
DOI: 10.12691/ajmcr-4-10-6
Open AccessCase Report

Isolated Cecal Necrosis Mimicking a Perforated Peptic Ulcer: A Case Report

Ognyan Georgiev Milev1, 2, and Lyudmil Lyubenov Milanov2

1Medical Center “Biomed 99”, 2 Targovska St, 3700 Vidin, Bulgaria

2Surgical Department, St Petka Multiprofile Hospital for Active Treatment, 119 Tsar Simeon Veliki St, 3700 Vidin, Bulgaria

Pub. Date: November 17, 2016

Cite this paper:
Ognyan Georgiev Milev and Lyudmil Lyubenov Milanov. Isolated Cecal Necrosis Mimicking a Perforated Peptic Ulcer: A Case Report. American Journal of Medical Case Reports. 2016; 4(10):349-353. doi: 10.12691/ajmcr-4-10-6

Abstract

Isolated cecal necrosis is a rare surgical emergency. In most cases the clinical picture resembles an acute appendicitis, usually occurring in elderly patients who have associated diseases. We believe that this is the first published case of isolated cecal gangrene, mimicking a perforated ulcer. A previously healthy 82-year-old male presented with abdominal pain, stabbing in nature, and of 12-hours duration. The clinical signs and symptoms were consistent with a perforated peptic ulcer. A plain abdominal X-ray disclosed a significant pneumoperitoneum. An emergency laparotomy released a gas under pressure revealing an isolated gangrenous cecum. Perforation of the cecum and fecal soiling were not present. A right hemicolectomy was performed. An intra-operative hemodynamic instability precluded primary anastomosis and a double barrel ileocolostomy was created. The patient was discharged in good health on the 8th postoperative day. This paper presents an original case of isolated cecal necrosis. A high index of suspicion should be maintained and the condition promptly addressed. Any delay is associated with high mortality rate. The procedure of choice is ileocecal resection or right hemicolectomy. The intestinal continuity should be restored through a primary anastomosis unless stump blood supply or peritoneal contamination, or patient’s overall condition are specific concerns.

Keywords:
cecal necrosis isolated perforation ulcer

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