Abstract
A man in his 50s presented with lower right abdominal pain from about 4 pm on the day of consultation at our hospital. Because symptoms rapidly worsened, he was transported by ambulance to our hospital. Physical findings on arrival showed tenderness and rebound pain in the lower right abdomen. Blood test findings revealed no abnormalities other than an elevated white blood cell count (20,500/mm3). Plain CT examination of the abdomen showed that the appendix was filled with fecaliths, with mild edema of the appendiceal wall and very mild swelling to 7 mm. Because we could not rule out the possibility of early appendicitis and in light of the intensity of lower right abdominal pain, same-day emergency surgery was performed. When the inside of the peritoneum was observed laparoscopically, the cecum was sallow and necrosis was suspected. Ileocecal resection was performed to remove the necrotic intestine, and functional end-to-end anastomosis was performed. Histological examination of the resected specimen showed necrotic findings, but no clear thrombus was evident in the blood vessels, including those of the mesenterium. A small range of gangrenous ischemic colitis was implicated as one possible cause of the cecal necrosis, due in part to the patient's history of arteriosclerotic disease.
