An Unlikely Cause of Abdominal Pain

Abstract

Cecal bascule is a rare subtype of cecal volvulus where the cecum folds anterior to the ascending colon causing intestinal obstruction. It is a challenging diagnosis to make in the emergency department, as the mobile nature of the cecum leads to a great deal of variation in its clinical presentation. Our discussion of a 78-year-old female who presented with abdominal pain and was found to have a cecal bascule requiring right hemicolectomy, demonstrates how emergency physicians must expand their differential diagnosis for patients reporting signs of intestinal obstruction. Though cecal bascule does not present often, the need for early surgical intervention necessitates a high level of clinical suspicion to prevent life-threatening complications.

Case-report: A rare cause of intestinal obstruction in late pregnancy

“…Caecal volvulus involves the axial twisting of the distal ileum, caecum and ascending colon on its mesenteric axis, thus causing intestinal obstruction. Torsion usually occurs in a clockwise pattern [ 1 , 2 ]. Delay in diagnosis or treatment, of both sigmoid and caecal volvulus; is associated with high morbidity.…”

“…Delay in diagnosis or treatment, of both sigmoid and caecal volvulus; is associated with high morbidity. Several studies report a mortality rate as high as 30–40%, in patients whom diagnosis and treatment of volvulus are delayed [ [1] , [2] , [3] ]. High mortality rates are attributed to the development of a closed loop obstruction, which can subsequently lead to ischemia, perforation, intra-abdominal sepsis and death [ 3 ].…”

“…A caecal bascule is an anatomical variant involving the caecum alone, folding upwards and anteriorly. Both however, present with similar clinical features and indeed share the same high mortality rates [ 1 , 2 ].…”

“…It is widely established that previous abdominal surgery, pregnancy (in particular during the third trimester), high fibre diets, pelvic masses and chronic constipation can contribute to the occurrence of caecal volvulus [ 1 , 3 , [6] , [7] , [8] ]. In pregnancy, as the uterus expands it displaces the mobile caecum which can precipitate malrotation [ 2 , 4 ].…”

Cecal Bascule in a COVID-19 Positive Patient: Case Report

“…Cecal bascule is a rare form of volvulus that is characterized by upward and anterior folding of the cecum. 5 Etiology is a multifactorial process and predisposing factors include failure of peritoneal fixation during embryonic development allowing for a free and mobile cecum, increased age, long-standing constipation, previous abdominal surgery, prolonged immobility, high-fiber diet, and use of psychotropic drugs. 5 In the presence of a competent ileocecal valve, cecal bascule may progress to closed loop obstruction.…”