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The Unusual Cecum

David Frager, MD; Ellen Wolf, MD; Thomas C. Beneventano, MD
JAMA. 1984;252(8):1049-1050. doi:10.1001/jama.1984.03350080051026.
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History  A 90-year-old woman was admitted to Montefiore Medical Center with a two-day history of severe right lower quadrant pain associated with nausea and vomiting. The patient's past medical record indicated a history of severe peripheral arterial disease, including bypass surgery, previous myocardial infarction, and right cerebral infarction. Physical examination showed right lower quadrant tenderness without peritoneal signs and a heme-positive stool. A blood examination revealed a hemoglobin level of 11.0 g/dL with hypochromic, microcytic indices.A barium enema study was obtained (Figs 1 and 2); the abnormalities demonstrated involved the cecum and ascending colon and will be described subsequently.

Diagnosis  Ischemic colitis involving the cecum and ascending colon.Figure 2 ("spot" film) demonstrates (1) a mass on the lateral surface of the ascending colon just above the ileocecal valve (black arrow); (2) edematous folds in the cecum (black arrowheads); (3) submucosal polypoid masses on the lateral wall of the


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