Isolated Cecal Necrosis: A Case Report and Scoping Literature Review

Isolated cecal necrosis (ICN), is a rare form of ischemic colitis in which ischemic injury is confined to the cecum. Because its symptoms frequently mimic acute appendicitis or other common abdominal pathology, diagnosis is often delayed, leading to significant morbidity and mortality. We present the case of a 72-year-old man who presented with acute right-lower-quadrant abdominal pain, following a syncopal episode during air travel. Computed tomography (CT) did not reveal intra-abdominal organ pathology, but raised the suspicion of acute-on-chronic occlusion of the proximal superior mesenteric artery, along with a previously undiagnosed intrarenal abdominal aortic aneurysm. Exploratory laparotomy showed localized cecal gangrene without perforation, and a right hemicolectomy with temporary abdominal closure was performed. A second-look operation confirmed bowel viability, allowing safe ileocolic anastomosis. Despite appropriate management, the patient suffered an acute myocardial infarction, developed multi-organ failure, and died on the fifth postoperative day. This case highlights an acute-on-chronic ischemic mechanism in a patient with extensive atherosclerosis and underscores the importance of early CT imaging and timely surgical intervention in elderly patients with vascular risk factors presenting with right-sided abdominal pain. We also provide a comprehensive review of the literature on ICN, discussing its pathophysiology, clinical presentation, diagnostic challenges, and management strategies.