Abstract

Introduction: Cecal volvulus accounts for 2-4% of all gastrointestinal obstructions and 1-2% of all large bowel obstructions. This often occurs when the cecum rotates along its long axis in relation to the terminal ileum and ascending colon. Cecal bascule is a rare type of cecal volvulus that occurs due to anteromedial folding of the cecum. Clinically, all forms of cecal volvuli are indistinguishable and the mortality rate is similarly high. However, abdominal imagining can distinguish cecal bascule from other forms of volvuli. We present a case of abdominal pain and colonic thickening on CT due to cecal bascule Case presentation: A 50 years old female with no significant medical history presented with 3 days of moderately severe cramping lower abdominal pain. She has prior history of hysterectomy. She denies any other complains including nausea, vomiting or constipation. No family history of colon cancer. Her physical exam was normal except for periumbilical tenderness on deep palpation. Labs were normal including urinalysis. CT scan of the abdomen showed thickened ascending colon and collapsed distal colon with hyperenhancing distended distal small bowel without associated whirling. Colonoscopy was done but could not be advanced beyond the ascending colon due to stricture. An air contrast barium enema showed severe ascending colon stricture with distended superior anteromedial cecal displacement suggesting cecal bascule. Laparoscopic ileocectomy was performed and cecal bascule was confirmed intraoperatively. The patient recovered well and was discharged home.Figure: Barium enema with dilated cecum.Figure: Ascending colon thickening and adjacent small bowel dilation.Discussion: Cecal bascule accounts for 0.01% of all large bowel obstructions. This occurs due to anteromedial folding of the cecum. On CT scan, axial torsion of the cecum is associated with the presence of a “whirl” sign that has never been reported in cecal bascule before. In this case, a barium enema is more beneficial in establishing the diagnosis. Colonoscopy is rarely required to diagnose or treat the condition and might in fact result in colonic perforation. Regardless of the type of cecal volvulus, treatment is primarily surgical. Gastroenterologists should be aware of this disorder especially prior to colonoscopy in patients with large bowel obstruction.

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