Cecal necrosis due to ischemic colitis mimicking an abscess on sonography

Ischemic colitis is a vascular disorder of the colon that causes rectal bleeding and abdominal pain in elderly patients.(1,2) It is classified into gangrenous and nongangrenous forms. Nongangrenous colonic ischemia usually requires only medical treatment and is associated with a good prognosis. In contrast, urgent surgical intervention is required for the treatment of gangrenous colonic ischemia, which is associated with high mortality.(3) Thus, in patients with ischemic colitis, it is especially important to determine whether colonic ischemia is the gangrenous or nongangrenous type. Endoscopic assessment of the colon is the most sensitive and reliable method of evaluating the ischemic colon mucosa(4); however, it is not always possible to perform a colonoscopic examination in patients with gangrenous ischemic colitis because of the severe general condition of these patients. Therefore, a noninvasive and rapid examination procedure is necessary for the diagnosis of gangrenous ischemic colitis. In this regard, a sonographic examination may be useful because it can be easily performed even in patients with shock status. In fact, several studies have reported that bowel wall thickening and decreased arterial flow in the affected colon are characteristic findings of patients with nongangrenous ischemic colitis(5-8); however, few articles have addressed the sonographic findings of gangrenous colonic ischemia. In this report, we describe the case of a patient with cecal necrosis due to ischemic colitis and discuss its unique sonographic findings.