Ischemic Necrosis of the Cecum: A Single Center Experience / 대한소화기학회지

BACKGROUND/AIMS: Isolated cecal necrosis is a rare cause of the surgical abdomen. Its manifestation is similar to that of acute appendicitis. Thirteen cases, who were pre-diagnosed with acute abdomen and were finally diagnosed with isolated cecal necrosis after operation have been evaluated alongside with literature. METHODS: The records of 13 patients, who had isolated cecal necroses between 1995 and 2011 at Necmettin Erbakan University Meram Medical School's General Surgery Clinic (Turkey), were retrospectively evaluated. RESULTS: Eight of the patients were male, whereas 5 were female. Their mean age was 68.0+/-11.7 (range 51-84) years. All the patients had at least one accompanying disease the most frequent of which were heart failure and chronic renal failure. Ten patients had right hemicolectomy and ileotransversostomy, two had right hemicolectomy and ileostomy, and one had wedge resection to the cecum by the help of linear stapler. Mortality was seen in 5 patients (38%) in the early postoperative period. CONCLUSIONS: Isolated cecal necrosis should be considered in elderly patients with chronic diseases presenting with sudden right lower quadrant pains in the differential diagnosis. Isolated cecal necrosis may have a bad prognosis since it is seen in elderly patients with accompanying problems. Therefore, early diagnosis and immediate surgical management if necessary is important to reduce the risk of morbidity and mortality.

Internal herniation as a major cause of intestinal obstruction

To evaluate internal herniation as a rare cause of intestinal obstruction. Files of 18 cases, operated due to internal herniation between 2000 and 2006 at Selcuk University, Meram School of Medicine, General Surgery Department, were reviewed retrospectively. Sixteen patients [88.8%] were male [mean age: 58.2 years; range: 42-67] and 2 were female [mean age: 56.5 years; range: 52-61].Cases were grouped according to the location of internal herniation, and the clinical findings and applied treatment strategies were evaluated. All patients were taken into surgical operation after preoperative preparations were completed. Findings were as follows: 6 cases of paraduodenal internal herniation, 4 of internal herniation through a defect in the terminal mesoileum, 2 of herniation through a defect in the falciform ligament, 2 of herniation through a defect in the omentum majus, 1 of herniation to the recessus over the bladder, 2 of herniation through a defect in the transverse mesocolon and 1 iatrogenically caused internal herniation through a defect in the mesojejunum. In an adult patient with findings of intestinal obstruction, diagnosis is difficult. Most cases presented to date are incidental findings during laparotomy, and surgical treatment is necessary