Cecal Perforation: All You Need to Know

Introduction:

The cecum is a part of the large intestine. Cecal perforation is a disease that can be due to perforation of the healthy colon. A few cases have been reported with it till now. It is a very rare disease found in people but has increased the risk of mortality. But if early detection of cecal perforation with surgical management is done, it can decrease the chances of mortality.

What Is Cecum?

It is the pouch that forms the first part of the large intestine. It acts as a connection between the small intestine and the large intestine, as it is located on the right lower abdomen near the appendix. It is also the first to receive digestive liquids from the small intestine.

What Is Cecal Perforation?

Cecal perforation is a perforation or an unusual, abnormal cecal opening formed by any of the reasons like infection, diverticulitis, foreign bodies, penetrating abdominal trauma, or volvulus. It involves the loss of regular continuity of the bowel wall or cecal. It leads to abdominal pain, which can be severe and sudden; along with it, the patient may also deal with constipation or diarrhea, nausea, and vomiting, according to the perforation condition.

What Are the Causes of Cecal Perforation?

Cecal perforation can occur due to many factors. Some of them are:

• Infection.

• Abscess.

• Inflammatory bowel disease.

• Diverticulitis - When a small bulge or pouch develops in the intestinal tract.

• Foreign body.

• Obstruction.

• Volvulus - An obstruction due to twisting and knotting of the intestinal tract.

• Penetrating abdominal trauma.

• Appendicitis.

• Blunt

• Tumor.

• Inflammatory conditions like Crohn’s disease.

• Pregnancy (usually in the third trimester).

• Colon enlargement.

• Violent coughing fits.

What Is the Pathophysiology of Cecal Perforation?

Cecal is an initial part of the large intestine and connects the small intestine to the colon. A perforation over the cecal area causes a mucosal layer of the cecum of the intestine to spill the air and the digestive contents into the peritoneal cavity. These contents can be highly acidic contents. The area with partial erosiveness can become a full-thickness tear.

What Are the Symptoms of Cecal Perforation?

Symptoms related to cecal perforation are:

• Fever.

• Chills.

• Severe and sudden abdominal pains.

• Nausea.

• Vomiting.

• Diarrhea.

• Constipation.

• Abdominal distention.

• Trouble while passing gas.

How to Diagnose Cecal Perforation?

Cecal perforation is not diagnosed only based on symptoms the patient provides to the doctor. If a cecal perforation is suspected, abdominal radiography is preferred.

• Abdominal Radiography: Abdominal radiography is done to diagnose intestinal obstruction. The radiography includes the small intestine and distended cecum in the right abdomen.

• Doppler Ultrasonography: Doppler ultrasonography is also used to diagnose the cecal perforation if any.

• CT Scan (Computerized Tomography): Computerized tomography is also one of the diagnostic methods to diagnose cecal perforations. CT here determines the distention, cecal apex in the left upper quadrant, mesenteric whirl, ileocecal twist, and slight bowel distention.

• Colonoscopy: Colonoscopy is done in cases where the doctor needs to examine the patient for changes in the large intestine if they are swollen, irritated, or dealing with cancerous cells. During the colonoscopy, a long, flexible tube is inserted into the rectum.

• Blood Tests: Blood tests are very important findings in any disease. The proper diagnosis demands the doctor to make the patient undergo blood tests as the anemia is usually present in the patient with perforation.

What Are the Complications of Cecal Perforation?

• Internal bleeding.

• Significant blood loss.

• Peritonitis.

• Permanent damage to the intestine.

If the cecal perforation continues untreated and management then, further severe effects can occur like:

• Sepsis.

• Septic shock.

• Strokes.

• Heart attack.

• Urinary tract infections.

• Death.

What Are the Risk Factors Related to Cecal Perforation?

• Any previous abdominal surgery.

• Age greater than 75 years.

• Medical history of the patient with at least one medical problem.

• Trauma to the abdomen or pelvis.

• History of inflammatory bowel disease.

• History of the patient with previous diverticular disease.

What Is the Treatment for Cecal Perforation?

The management of cecal perforation is very important to prevent any further complications in the patients.

• The patients are managed by treating with intravenous access and initiating crystalloid therapy in patients presenting signs of septicemia.

• The patient should be given antibiotics. If there are large perforations, then an ostomy is done.

• Suppose the perforation is small, then primary closure of the defect with ileostomy (surgical operation in which the damaged part is removed) or primary closure with or without omentoplasty (surgical procedure in which the omentum is used to cover or fill a defect) and right hemicolectomy (procedure to remove one side of the colon). If the cases are uncomplicated, then primary repair is done by omental patch or right hemicolectomy is advised.

• Surgical therapy is required to remove any foreign materials in the peritoneal cavity.

• There are conventional, or mini-laparotomy done to manage the perforation. But surgical management depending upon the cause of perforation is done.

• It is an opening through the abdominal wall that allows intestinal contents to exit away, and a bag holds the contents for emptying. During the surgery, the doctors need to clean the abdominal cavity and remove infected tissues.

What Is the Contraindication to Surgery for Cecal Perforation?

Contraindications to surgery for cecal perforation are

• If the patient refuses to sign the informed consent.

• If the patient is suffering from severe heart failure or respiratory failure.

Conclusion:

Cecal perforation is erosion or tear of the cecum mucosal water that forms a perforation in the cecum area of large Cecal perforation is a very rare disease that causes the patient to die if not detected and treated on time. So, early detection and management are important in these cases. With early detection, the doctor recommends the patient perform the complete blood count test, CT scan (computerized tomography), abdominal ultrasonography, etc. The patient on cecal perforation can show symptoms like abdominal pains, vomiting, and nausea. In addition, the patient can have internal bleeding from the perforation. It is treated by giving antibiotics to the patient and if large perforation occurs then an ostomy is done. If small perforation is present then the doctor can treat it by ileostomy in which a part that is perforated is removed.