The threatened caecum in acute large-bowel obstruction.

The recognition of intramural caecal gas as a sign of necrosis and incipient caecal rupture in cases of acute large-bowel obstruction is emphasised. Gas was noted within the caecal wall in two cases of large-bowel obstruction due to recto-sigmoid carcinoma. At operation the proximal large bowel was found to be non-viable in one of these, and the other required a repeat operation for gangrenous bowel two days after the initial procedure. These cases illustrate the importance of specifically looking for intramural caecal gas in patients with acute large-bowel obstruction, and its value in identifying the threatened caecum, especially if marked distension is present.