Cecal Bascule: A Rare Entity Managed Endoscopically

Colonic Volvulus

“…1 ). 18 19 21 24 Axial volvulus develops from clockwise twisting of the cecum along its long axis in which the cecum remains in the right lower quadrant. Loop volvulus involves twisting of the cecum and a portion of the terminal ileum.…”

“…Bascule is less common than axial or loop volvulus, accounting for approximately 20% of cecal volvulus cases, 18 19 21 and has a lower risk of ischemia due to the lack of torsion. 24 There is a slight male predominance in cecal bascule, and patients tend to be in the fifth or sixth decade of life. 21 The development of cecal bascule is thought to be secondary to adhesions, which can be either congenital or acquired from prior surgical procedures or intra-abdominal inflammation, although bascule has also been described in cases of colonic pseudo-obstruction (Ogilvie's syndrome), ileus, neurogenic bowel, poor perfusion states such as critical illness, and pregnancy.…”

“…9 Some patients, especially those with cecal bascule, will also have a history of mobile cecum syndrome, which consists of recurring symptoms of generalized or localized right lower quadrant pain and distention that resolves with passing flatus. 9 20 24 These patients may ignore their symptoms for longer or present to the hospital later, increasing their risk of ischemia on presentation. Providers should have a high index of suspicion when patients report a history consistent with mobile cecum syndrome and should initiate workup for cecal volvulus in a prompt fashion.…”

“…1 17 19 22 In cecal bascule in particular, there is a single case report that describes successful endoscopic management, but nearly all other cases in the literature required surgical intervention. 21 24 As such, all patients with cecal volvulus should get an immediate surgical consult and consideration for emergency surgery.…”