Isolated cecal necrosis following COVID-19 infection: a rare challenging diagnosis – a case report

Introduction: Isolated cecal necrosis (ICN) is a rare acute abdominal condition that can mimic appendicitis due to nonspecific clinical and imaging findings. It is classified as spontaneous, when no clear cause is identified, or secondary, when poor mesenteric perfusion is present. We present a case of ICN with cecal perforation following recent COVID-19 infection. Presentation of Case: A 75-year-old hypertensive male with a recent COVID-19 infection presented with acute abdominal pain and fever. Examination revealed right iliac fossa tenderness with guarding. Laboratory tests showed marked leucocytosis and elevated CRP. A contrast-enhanced CT scan demonstrated cecal wall thickening with pneumoperitoneum, while the appendix appeared normal and mesenteric flow was preserved. Emergency laparotomy confirmed isolated cecal ischemia with perforation and localized stercoral peritonitis. The patient underwent a right colectomy with ileocolostomy, and histopathology verified the diagnosis of ICN. Postoperative recovery was uneventful. Discussion: ICN primarily affects elderly patients with comorbidities compromising mesenteric perfusion. Recent literature indicates that COVID-19 may predispose patients to colonic ischemia via microvascular thrombosis. Preoperative diagnosis is challenging due to its nonspecific presentation. Surgical intervention remains the cornerstone of management. Conclusion: ICN should be considered in patients with right iliac fossa pain and potential mesenteric perfusion compromise, with urgent surgery being essential, especially in the context of recent COVID-19 infection.