A Rare Case of Cecal Bascule in a Child With Normal Neurodevelopment

Abstract

Cecal volvulus is a rare cause of bowel obstruction in adults and an extremely rare presentation in children. One form known as a cecal bascule has only previously been reported in children with neurodevelopmental issues or with severe chronic constipation. We present the case of a 10-year-old boy who presented with an acute history of left lower quadrant abdominal pain, who upon investigation was found to have a cecal bascule.

A systematic review of the management and outcomes of cecal and appendiceal volvulus in children

“…The literature search revealed 76 papers, with 24 meeting the inclusion criteria, as detailed in Figure . All the papers included in this review were case reports, with a total of 29 patients, as detailed in Table . The median age was 10 ± 4.5 years, with a range of five days to 15 years, and the patients were predominantly male (72%).…”

“…Overall, a preoperative diagnosis of volvulus was made in nine children (31%) . In the other cases, interventions were indicated due to a clinical and radiological diagnosis of bowel obstruction in 18 cases , pneumoperitoneum in one and appendiceal abscess in another patient .…”

“…It might show markedly dilated bowel loops, with occasional air fluid levels and cecal distension, or one prominent segment of dilated bowel . Even when CV was not diagnosed, it showed evidence of bowel obstruction, which was enough to initiate management .…”

“…Contrast enemas and computed tomography were specific, but both demanded time. The former offered risk of perforation and the latter was not available all the time in all centres . Ultrasound may have shown twisted ileocecal vessels, but it was operator dependent .…”

“…Cecal volvulus (CV) and appendiceal volvulus (AV) are rare conditions and occur so infrequently in children that the true incidence is unknown . As far as surgical management is considered, appendectomy is recommended in all AV cases .…”