Primary Cecal Pathologies Presenting as Acute Abdomen

Primary Cecal Pathologies Presenting as Acute Abdomen and Critical Appraisal of Their Current Management Strategies

Background: The importance of cecal pathologies lie in the fact that being the first part of large intestine, any disease involving the cecum affects overall functioning of the large bowel. Primary cecal pathologies presenting as acute abdomen have not been described in any previous study in terms of presentation, management and outcome.

Objectives: The objective of this study was to identify the reported causes of primary cecal pathologies presenting as acute abdomen and the various causes presenting in Indian setting, to discuss morbidity and mortality associated with cecal pathologies and to critically analyse the various management modalities employed in emergency setting.

Study Overview

• Status: Completed
• Conditions: Laparotomy; Acute Abdomen; Emergency Surgery; Amoebic Colitis; Diverticulitis of Caecum; Typhlitis
• Intervention / Treatment: Procedure: Operated

Detailed Description

The importance of cecal pathologies lie in the fact that being the first part of large intestine, any disease involving the cecum affects overall functioning of the large bowel. Primary cecal pathologies presenting as acute abdomen often pose a challenge to their optimal management due to requirement of urgent intervention in most cases and being a common source of misdiagnosis. These pathologies often mimic acute appendicitis and commonly misdiagnosed as one. This misdiagnosis can lead to under-treatment of the underlying pathology and this results in high morbidity and mortality associated with these conditions. So the accurate identification of such conditions is required so that the patients can be optimally managed and patient outcome can be improved.

• Study Type: Observational
• Enrollment (Actual): 43

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All adult patients presenting in the emergency department with acute abdomen were included in study in whom cecal pathology as the cause of acute abdomen was suspected clinically and/or on imaging and further confirmed per-operatively and/or on histopathological examination (HPE) or on imaging.

Description

Inclusion Criteria:

• All adult patients presenting in emergency department with acute abdomen were included in study in whom cecal pathology as the cause of acute abdomen was suspected clinically and/or on imaging and further confirmed per-operatively and/or on histopathological examination (HPE) or on imaging. Patients identified with primarily a cecal pathology who had acute pain abdomen as the initial symptom but who didn't presented immediately due to various reasons were also included in the study as it is a well-documented fact that patients in developing countries like India, especially those who live in rural areas or who are illiterate often resort to indigenous methods of treatment or take symptomatic treatment from local practitioners before presenting to a tertiary centre for definitive treatment. Also, only those patients who were operated within 24 hours of index admission in the emergency operation theatre (EOT) by a registrar or faculty member after initial resuscitation were included in the study.

Exclusion Criteria:

• Patients with sub-acute, intermittent or chronic pain; when predominant symptoms were attributable to some other cause even with concomitant presence of a cecal pathology; when predominant pathology was not cecal and patients with cecal pathology operated as an elective case were excluded from this study. Thus patients diagnosed to be having appendiceal stump blowout, perforation of base of appendix, ileocecal tuberculosis or intussusception were not included.

Study Plan

How is the study designed?

Number of groups / cohorts

4

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Operated patients who survived; Patients who were discharged in index hospital admission after operative intervention	Procedure: Operated; Patients were either managed conservatively or underwent emergency laparotomy
Operated patients who expired; Patients who expired in index hospital admission after operative intervention	Procedure: Operated; Patients were either managed conservatively or underwent emergency laparotomy
Non-operated patients who survived; Patients who were discharged in index hospital admission after being managed conservatively
Non-operated patients who expired; Patients who expired in index hospital admission after being managed conservatively

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pattern of primary cecal pathology in Indian setting	The objective of this study was to identify the reported causes of cecal pathology presenting as acute abdomen in medical literature and the various causes presenting in Indian setting, to identify the pattern of common pathologies in Indian setup, to discuss morbidity and mortality associated with cecal pathologies and to critically analyse the various management modalities commonly employed for cecal pathologies presenting as acute abdomen.	10 years

Collaborators and Investigators

• Sponsor: Jawaharlal Nehru Medical College

Study record dates

Study Major Dates

• Study Start (ACTUAL): January 1, 2016
• Primary Completion (ACTUAL): May 31, 2017
• Study Completion (ACTUAL): July 15, 2017

Study Registration Dates

• First Submitted: August 23, 2017
• First Submitted That Met QC Criteria: August 24, 2017
• First Posted (ACTUAL): August 25, 2017

Study Record Updates

• Last Update Posted (ACTUAL): August 25, 2017
• Last Update Submitted That Met QC Criteria: August 24, 2017
• Last Verified: August 1, 2017

More Information

Terms related to this study

• Keywords: Ileocecal resection; Right hemicolectomy; Emergency laparotomy; Primary cecal pathology; Ruptured liver abscess; Conservative colonic resection; Fulminant amoebic colitis; Ileoascending anastomosis; Ileotransverse anastomosis; Cecal diverticulitis; Amoebic typhilitis; Idiopathic typhilitis
• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; Infections; Pain; Neurologic Manifestations; Disease Attributes; Signs and Symptoms, Digestive; Gastrointestinal Diseases; Gastroenteritis; Colonic Diseases; Intestinal Diseases; Intestinal Diseases, Parasitic; Parasitic Diseases; Protozoan Infections; Cecal Diseases; Diverticular Diseases; Dysentery; Intraabdominal Infections; Enterocolitis; Abdominal Pain; Enterocolitis, Neutropenic; Emergencies; Colitis; Diverticulitis; Abdomen, Acute; Amebiasis; Dysentery, Amebic; Typhlitis
• Other Study ID Numbers: CecalJNMC

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED
• IPD Plan Description: Data can be shared on request for multi-institutional prospective studies.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No