Soft-tissue images. Segmental colonic ischemia mimicking appendicitis.

ted with a 1-day history of abdominal pain on the right side. Results of abdominal computed tomography done at another hospital the evening before were normal. The patient also had anorexia, nausea, vomiting and diarrhea, and she smoked. Three months earlier she had had a myocardial infarction treated by percutaneous transluminal coronary angioplasty and insertion of a stent. One month later echocardiography showed only minimal abnormality of ventricular wall motion and no mural thrombus. She was taking lovastatin, metoprolol, lisinopril, levothyroxine, conjugated estrogens and acetylsalicylic acid. On physical examination she was found to have a low-grade fever and local rebound tenderness in the right portion of the midabdomen. A stool sample was negative for occult blood. The leukocyte count was 16.3 × 109/L. Exploratory laparotomy for suspected appendicitis revealed segmental ischemia of the ascending colon (Fig. 1). A right colectomy was done. Her recovery was uncomplicated. Histologic examination of the biopsy specimen showed focal fullthickness necrosis and normal mesenteric vessels. Segmental ischemia of the right side of the colon is a rare cause of abdominal pain. Emboli, vasculitis or systemic hypotension may cause this condition, and treatment usually should include resection of the abnormal segment of the colon. For older patients with a normal appendix and right-sided abdominal pain, the differential diagnosis should include segmental ischemia of the right side of the colon.