English

Abstract

Caecal volvulus is a rare condition and caecal bascule, a variant of caecal volvulus is even rarer. Despite similar clinical presentation, initial vigil during clinical examination helps in furthering the diagnosis. The objective of treatment in case of caecal volvulus is to avoid any complication such as gangrene with resection being the only choice if gangrene has already developed. The present case of a 53 year old male, is a typical representation of a caecal volvulus complicated by presence of gangrene confirmed on laparotomy. Resection of 5.7 cm of involved gangrenous part averted any further complication. Follow-up and reversal of ileostomy was done after 6 weeks with an ileo-ascending anastomosis. No complication was reported during the follow up. INTRODUCTION: Cecal volvulus is a rare condition, and its incidence is reported to range from 2.8 to 7.1 per million people per year [1]. It is characterised anatomically by the axial twisting that occurs involving the caecum, terminal ileum, and ascending colon [2, 3]. Caecal bascule is a variant of this condition associated with the upward and anterior folding of the ascending colon and accounts for about 10% of all caecal volvulus case sp [3]. Despite anatomical differentiation, the clinical profile of caecal volvulus and caecal bascule is very similar and is often manifested in terms of intestinal obstruction and strangulation [2, 3]. Clinical presentation of volvulus cases is very diverse and is characterized by intermittent episodes of abdominal pain to unbearable pain leading to medical emergencies [3, 4]. Owing to its rare occurrence, it is difficult to diagnose. In this paper, we report a case of cecal volvulus with extremely rare caecal bascule variant seen in a 55-year-old man, diagnostic method, treatment planning and management of the case is discussed CASE REPORT: A 55 year old male presented with complaints of pain for the last 5 days followed by distension of abdomen for the last 2 days. He was also vomiting for the past 24-hours. On examination, generalized distension with tenderness was felt. Tympanic note over left upper quadrant was noticed. There were no bowel sounds and no evidence of sepsis. Erect X-Ray of abdomen showed dilated small bowel loops with a large gas-filled loop with haustrations placed obliquely which are characteristic of caecal bacsule. On exploratory laparotomy, caecum & appendix were found to be gangrenous and lying over splenic flexure of colon. Resection of gangrenous segment 5.7 cm in length was done with exteriorization of ileum & ascending colon. Patient recovered and was discharged with ileostomy in situ on day ___. Follow-up and reversal of ileostomy was done after 6 weeks with an ileo-ascending anastomosis.