Acute necrotizing colitis with cecal perforation in a patient with autosomal dominant polycystic kidney disease: a case report

Autosomal dominant polycystic kidney disease (ADPKD) is a common hereditary disorder with both renal and extrarenal manifestations. While hepatic cysts and intracranial aneurysms are well-known complications, gastrointestinal involvement is rarely reported. Colonic perforation and necrotizing colitis in ADPKD patients, especially those undergoing dialysis, represent an unusual and serious clinical scenario. We report a rare case of acute necrotizing colitis with cecal perforation in a 50-year-old female with a known history of ADPKD, hypertension, and end-stage renal disease on dialysis. The patient presented with vague abdominal pain, systemic signs of sepsis, and was found to have free intraperitoneal air. Exploratory laparotomy revealed cecal perforation with necrotic segments, prompting ileocecal resection. Histopathological examination confirmed acute necrotizing colitis with two perforated ulcers. The case underscores the importance of early recognition and intervention in ADPKD patients presenting with acute abdomen, highlighting an uncommon but life-threatening complication.