Modified Graham patch repair for cecal perforation: A case report.

INTRODUCTION AND IMPORTANCE: Acute appendicitis is a common cause of acute abdomen worldwide. The complications associated with it can sometimes be unpredictable and pose a dilemma in the management of such complications. CASE PRESENTATION: A case of 18 year female with complaints of right iliac fossa pain and vomiting was diagnosed clinically as acute appendicitis and underwent emergency open appendectomy where a cecal perforation was encountered intra-operatively for which a Modified Graham's Patch Repair was done. CLINICAL DISCUSSION: Acute appendicitis can sometimes present with complications like perforation, among which cecal perforation is rare and difficult to diagnose in the initial setting. Perforated appendicitis or colon can increase morbidity and mortality significantly. High degree of suspicion and early surgical approach can lead to identification of rare complications, which can still pose a surgical dilemma on the approach of management. CONCLUSION: Cecal perforation in suspected acute appendicitis is a rarely encountered intra operative complication. Management approaches can range from less invasive suture with omental patch repair to more invasive right hemicolectomy.

Migrated Plastic Biliary Stent Causing Cecal Perforation.

Plastic biliary stents can spontaneously dislodge from the common bile duct and migrate distally into the bowels. Most migrated plastic biliary stents get passed with stools without any complication. However, in rare cases, migrated biliary stents can cause bowel perforation requiring urgent intervention. We report a rare case of a 53-year-old woman presenting with severe lower abdominal pain secondary to migrated plastic biliary stent causing cecal perforation. Computed tomography revealed a radiopaque linear foreign body within the cecum. The patient underwent emergent laparoscopy with stent removal and was discharged 2 days later without long-term complications.

Necrotizing Fasciitis Masquerading as Stroke: A Diagnostic Dilemma.

Necrotizing fasciitis (NF) poses a diagnostic challenge due to its rarity and similarity in presentation with other critical conditions. We report a case of a 79-year-old male who initially presented with altered mental status and stroke-like symptoms; he was ultimately diagnosed with abdominal wall NF spreading to the lower extremity. Despite a history of cecal mass perforation noted in prior imaging, the patient had been discharged from an outside emergency room on antibiotics, highlighting a missed opportunity for early intervention. Subsequent deterioration led to sepsis, organ failure, and ultimately, the detection of NF. Prompt recognition of subtle skin changes and laboratory abnormalities, along with a detailed physical examination, is essential for a timely and accurate diagnosis. Surgical debridement, coupled with broad-spectrum antibiotics, remains the cornerstone of treatment. Delays in surgical management significantly increase mortality, emphasizing the importance of prompt diagnosis and intervention. This case underscores the necessity for heightened awareness among healthcare providers to recognize NF promptly, especially when its clinical presentation overlaps with other critical conditions. Multidisciplinary collaboration and continued education are imperative to improve outcomes and prevent delays in the diagnosis and treatment of NF.

Intussusception of Heterotopic Gastric Mucosa in the Transverse Colon: A Rare Cause of Perforation and Bleeding.

Heterotopic gastric mucosa in the colorectal region is a rare condition and can be found throughout the gastrointestinal tract. Intussusception in adults is mostly associated with adenocarcinoma and requires prompt surgical intervention, especially in cases of intestinal perforation. Our case report demonstrates a cecal perforation caused by the intussusception of heterotopic gastric mucosa within the transverse colon. The patient presented with substantial hematochezia. Despite the challenges of diagnosing this condition preoperatively and in the ICU, accurate pathologic evaluation is important. The consideration of a heterotopic gastric mucosa is crucial in cases of persistent hematochezia, especially in cases of intussusception. The postoperative course of the patient was characterized by hematochezia, which improved with proton pump inhibitors. The consideration of the possibility of heterotopic gastric mucosa may be a guide to appropriate surgical management and optimization of patient outcomes.

Spontaneous Cecal Perforation During Pregnancy.

Spontaneous perforation of the colon is a rare disease defined as sudden perforation of a healthy colon without evidence of trauma or disease. These perforations are typically classified as either stercoral or idiopathic. Cecal perforation during pregnancy is an uncommon and potentially life-threatening condition requiring prompt recognition and surgical intervention. We present a case of a 33-year-old woman at 29 weeks and three days gestation presenting with spontaneous cecal perforation. She presented to the emergency department with diffuse abdominal pain and distention lasting for three days, associated with nausea and vomiting. Following evaluation, she was diagnosed with diffuse peritonitis. The diagnosis of this condition relies on both the clinical presentation and the utilization of radiographic imaging. The patient underwent an emergent explorative laparotomy with prompt surgical intervention to repair the 1.2 x 0.8 cm perforation found on her distended cecum. The surgical repair consisted of the excision of the edges and the primary suture of the perforation with an omental patch. Her post-procedure course was uneventful, and she later delivered a healthy baby at full term. This case highlights the importance of considering uncommon causes of acute abdominal pain in pregnant women to ensure timely diagnosis and management.

A rare case of cecal foreign body leading to cecal perforation in 12-year-old child: a clinical case report and review of literature.

Introduction and importance: Cecal foreign bodies are uncommon causes of acute abdomen, and their presentation can often mimic acute appendicitis (AA), making it challenging to diagnose. The authors present the case of a 12-year-old male from Ethiopia who initially presented with symptoms suggestive of AA. However, during surgery, the authors found a multiple magnetic fields result in perforation. This case highlights the importance of considering unusual etiologies. Case presentation: A 12-year-old boy with AA associated with anorexia, nausea, and low-grade fever was referred from a private clinic. Otherwise, no history of recent respiratory infection and diarrhea, and was previously in good health. The patient did not report any history of a foreign body (FB), even to his own family, and, except for himself, no one was aware of the ingested FB. The work has been reported in line with the Surgical CAse REport (SCARE) 2023 criteria. Discussion: In this case, the authors experienced multiple magnetic FB in the cecum, which were not observed on ultrasound (U/S). However, this case closely resembled appendicitis. U/S can aid in differentiation. However, it may not always identify the underlying etiology, specifically in a resource-limited setting. Conclusion: Based on the patient's presentation, AA was diagnosed and emergency surgery was presumed to be inflamed. However, three magnetic FB were the underlying cause of the presentation, which created pressure on the cecal wall, and the authors successfully performed surgical management. This case reminds us of uncommon etiologies, such as magnets in patients with symptoms of appendicitis. This underscores the importance of an open-minded approach to unexpected findings during surgery.

An Unusual Case of Cecal Perforation: Accidental Ingestion of a Tooth in an Elderly Trauma Patient.

Foreign body ingestion is a common occurrence in the United States, with the majority passing asymptomatically. In cases where complications occur, such as intestinal perforation, it may present as an acute abdomen with diagnostic challenges regarding the etiology. A 70-year-old male was brought to the emergency department (ED) after he jumped from the second floor of a burning building, sustaining 10% second-degree burns to his forearms. He was intubated for concerns of inhalational injury and resuscitated. His intensive care unit (ICU) course included the management of respiratory failure, sepsis, and acute kidney injury. On hospital day 28, imaging showed moderate pneumoperitoneum with ascites. He was taken for abdominal exploration, during which it was noted that there was gross fecal contamination and a 1 cm cecal perforation. After resection of the ileocecum, it was left in discontinuity due to hemodynamic instability and contamination. He was brought for a second-look laparotomy in 48 hours, and an incisor tooth was found in the right pelvis, and an ileocolic (ileum-ascending colon) anastomosis was performed. His post-operative course was complicated by an anastomotic leak and an intra-abdominal collection. Despite attempts at source control with percutaneous drainage, the patient remained septic with a poor prognosis. Goals of care were discussed, and the decision was made to de-escalate care. Although there is literature on foreign body ingestion resulting in intestinal perforation, there is a paucity of literature highlighting the importance of dental exams in elderly trauma patients, the incidence of perforation due to tooth ingestion, and maintaining a high index of suspicion for an acute abdomen in unusual presentations of sepsis.

Complicated acute appendicitis with compromised appendiceal base: A review of surgical strategies.

<b><br>Introduction:</b> Acute appendicitis is one of the most frequent emergencies in hospitals around the world; it requires early surgical treatment in complicated cases. One of the challenges that the surgeon faces during appendectomy is when the base of the appendix is compromised by either a perforation or gangrene. To show the surgical strategies that have been reported, as well as the complications associated with a compromised appendicular base in a complicated acute appendicitis.</br> <b><br>Methods:</b> A bibliographic search was carried out in the databases of Pubmed, Embase, Web of Science, and Google Scholar. The search expression ("appendiceal stump closure" OR "Closure of the appendiceal stump" OR "Management of appendiceal stump") was used to search for articles. The inclusion criteria were observational studies (case reports, case series, or cross-sectional, case-control, or cohort studies).</br> <b><br>Discussion:</b> Different techniques have been reported for the treatment of a compromised appendicular base. Among the most used are primary closure, partial resection of the cecum, cecostomy tube, ileocecectomy, and right hemicolectomy. The most frequent complications are surgical site infection, intra-abdominal abscess, postoperative ileus, intestinal obstruction, and others.</br> <b><br>Conclusions:</b> The appendicular base, compromised by necrosis or perforation, requires adequate treatment in order to prevent dehiscence of the appendicular stump sutures and fecal peritonitis. A number of surgical options have been reported.</br>.

Ogilvie's Syndrome with Perforation Peritonitis after Caesarean Section.

Acute colonic pseudo-obstruction in the immediate post-partum period, following Caesarean section is rare, and requires a high index of suspicion for diagnosis. Sometimes, rapidly progressive dilatation of the caecum can lead to perforation peritonitis. There are only a few case reports describing this important entity. Presented herein is a young primigravida, who developed Ogilvie's syndrome and peritonitis 5 days following an uneventful elective Caesarean section. Clinical details, management strategy adopted and a brief review of literature is presented to draw attention to this condition.

Cecal perforations due to descending colon obstruction (closed loop): a case report and review of the literature.

BACKGROUND: Cases of large bowel closed-loop phenomenon with cecal perforation are extremely rare, especially when extracolonic epiploic appendage and peritoneal bands are the cause. However, sporadic cases exist in the literature with various presentations, but very few occur in patients in the abdomen without a previous scar. CASE PRESENTATION: An 89-year-old Sudanese farmer was admitted to the emergency department with 9-day history of generalized colicky abdominal pain, abdominal distension, anorexia, persistent vomiting, and constipation. Given his clinical presentation and assessment, he was diagnosed with peritonitis due to a perforated viscus in a virgin abdomen. Operative exploration revealed an extraluminal left-sided omento-epiploic band that resulted in closed-loop colonic obstruction with secondary multiple cecal perforations. Standard right hemicolectomy with adhesiolysis was done. Postoperative wound infection and hypoalbuminemia were treated, and the patient was discharged on postoperative day 9 on a regular oral diet. CONCLUSIONS: Although this condition is rare, it can be extremely dangerous, requiring prompt investigation and surgical intervention. It usually occurs secondary to raised intraluminal pressure with subsequent ischemia of the cecal wall. Through this case report, we aim to reflect on this rare experience, shedding light on the benign, extracolonic pathologies that can be life threatening or even fatal.