A Case of Isolated Cecal Necrosis Preoperatively Diagnosed with Perforation of Cecum

Isolated Cecal Necrosis Mimicking a Colonic Mass

Isolated cecal necrosis (ICN) is a rare form of ischemic colitis that can mimic conditions such as appendicitis, malignancy, or diverticulitis. Most cases of ICN have been identified in patients with significant comorbidities that increase risk of vascular disease. We present a case of ICN mimicking a mass lesion in an elderly patient with few comorbid conditions. Although computed tomography was concerning for colonic mass, diagnostic colonoscopy revealed ischemic colon. The patient underwent right hemicolectomy, and pathology confirmed ICN. It is important to recognize conditions ICN can mimic, understand ICN can present without acute abdomen, and consider ICN in the differential diagnosis even in relatively healthy patients without a history of vascular disease.

Partial Infarction of Cecal Wall Presenting as Acute Appendicitis

Acute appendicitis is one of the most common causes of acute abdomen in children and young adults, with differential diagnoses involving several surgical, medical as well as obstetrics and gynecology (OB-GYN)-related conditions. Cecal wall necrosis is not usually included in the differential diagnosis of acute appendicitis, mainly because of the rare nature of the condition and the relatively low level of awareness among surgeons. We present a case of isolated cecal wall necrosis presenting as acute appendicitis. It involves a 42-year-old male patient who presented to the emergency department (ED) of our hospital with abdominal pain for three days. The pain was felt over the right lower quadrant and was associated with nausea, vomiting, and anorexia. The case was diagnosed as acute appendicitis and the patient was taken to the operating room (OR). Upon entering the abdomen, necrosis of the anterolateral wall of the cecum was discovered with a normal appendix. Resection of the cecum was performed, followed by ileocolic anastomosis. The patient was discharged in good condition after 10 days of hospital stay. This case report highlights the importance of considering cecal wall necrosis in patients presenting with right lower quadrant abdominal pain who display atypical signs and symptoms of appendicitis; we also wish to promote awareness among surgeons about this rare condition.

Recent advances in systemic therapy for hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common and lethal malignant tumors in the world. Therapeutic options for advanced HCC are limited. Systemic treatment, especially with conventional cytotoxic drugs, is usually ineffective. For more than a decade, sorafenib has been the only systemic drug that has been proven to be clinically effective for treating advanced HCC. However, over the past three years, the rapid progress of molecular targeted therapies has dramatically changed the treatment landscape for advanced HCC. Immune checkpoint therapies are now being incorporated into HCC therapies, and their combination with molecular targeted therapy is emerging as a tool to enhance the immune response. In this review, we summarize the development and progress of molecular targeted agents and immunotherapies in HCC.

Isolated cecal necrosis: Report of two cases

Isolated cecal necrosis is a rare variant of ischemic colitis. Diagnosis is difficult because of nonspecific clinical and radiological findings. It especially affects patients with comorbidities affecting mesenteric perfusion.

Accuracy of Nonenhanced CT vs Contrast-Enhanced CT for Diagnosis of Acute Appendicitis in Adults

BACKGROUND

Acute appendicitis is one of the most common causes of acute abdominal pain requiring emergency intervention. It is often difficult for the clinician to make an accurate diagnosis due to nonspecific and overlapping clinical symptoms. Computed tomography (CT) has become the imaging modality of choice for the evaluation of suspected acute appendicitis. The main purpose of our study was to compare nonenhanced CT (NECT) with contrast-enhanced CT (CECT) for the diagnosis of acute appendicitis.

MATERIAL AND METHODS

A total of 140 patients were enrolled in the study. Two abdominal radiologists-masked to both the clinical information and the final diagnosis-retrospectively reviewed the computed tomographic findings and made an imaging diagnosis based on (1) NECT only, (2) CECT only, and (3) both NECT and CECT. With the final diagnosis as the reference standard, the accuracy of each CT technique was estimated.

RESULTS

The respective sensitivity, specificity, and accuracy for NECT, CECT, and NECT + CECT for the diagnosis of acute appendicitis were 80.7%, 86.7%, and 84.3%; 86.0%, 81.9%, and 83.6%; and, 87.7%, 80.7%, and 83.6%. There was no significant difference in the diagnosis of acute appendicitis among the 3 techniques. In order to make a correct diagnosis, the presence of at least 3 imaging findings for NECT or at least 4 for CECT had the best diagnostic accuracy. We also found that 9.25 mm was the optimal cut-off threshold for the detection of patients with acute appendicitis.

CONCLUSION

Our study allowed direct comparison between NECT, CECT, and NECT + CECT combined. There was no difference in the ability of each CT technique for diagnosing patients with acute appendicitis. For a patient whom iodinated contrast media is contraindicated or a patient who has an increased risk of severe adverse reaction, we would encourage the use of NECT because it provides comparable diagnostic accuracy without further exposing such patient to the contrast media.