Isolated Cecal Pole Ischaemia: A Rare and Underrecognised Variant of Acute Mesenteric Ischaemia Mimicking Acute Appendicitis

Isolated caecal pole ischaemia is a rare and often underrecognised variant of acute mesenteric ischaemia (AMI) that can closely mimic the clinical presentation of acute appendicitis. This case report describes a 78-year-old man who presented with right iliac fossa pain and vomiting. Initial investigations suggested acute appendicitis; however, contrast-enhanced computed tomography (CT) revealed an ischaemic caecum and an occluded superior mesenteric artery (SMA). Despite conservative management, the patient's condition deteriorated, and exploratory laparotomy revealed a gangrenous cecal pole, prompting ileocecal resection. Histopathology confirmed ischaemic necrosis, and the patient recovered well postoperatively. This case highlights the diagnostic challenges associated with isolated caecal pole ischaemia and underscores the importance of early imaging and surgical intervention, especially in patients with significant vascular risk factors.