Cecal Bascule: An Overlooked Diagnosis in the Elderly

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.

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“… 9 As vascular compromise progresses, these patients may begin to demonstrate signs of peritoneal irritation. 11 …”

Section: Discussionmentioning

confidence: 99%

An Unlikely Cause of Abdominal Pain

Kairys¹,

Skidmore²,

Repanshek³

et al. 2018

CPC-EM

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“…Caecal volvulus is the second most common to get affected after sigmoid. 1 Colonic volvulus is an emergency condition where part of the colon twists around its axis due to presence of large, mobile segment of colon with a small mesenteric fixation resulting into partial or complete bowel obstruction with variable degree of compromise of its blood supply. Caecal volvulus is an uncommon clinical condition accounting for less than 2% of all adult intestinal obstruction.…”

Section: Pathological Discussionmentioning

confidence: 99%

Caecal Volvulus- A Case Report

Kishore¹

2018

jemds

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CASE PRESENTATION An 18-year-old female presented to surgical emergency with complaints of progressive abdominal distension, vomiting, constipation and fever of 3 days duration. On examination, she was febrile. Abdomen was distended with hyperperistaltic bowel sound and on per rectal examination rectum was empty. Routine blood examinations showed raised total leucocyte count and increased blood urea. X-ray abdomen showed dilated small bowel with multiple fluid level (Figure 1). With the x-ray findings, we made a diagnosis of small bowel obstruction. Initially patient was stabilised, treated conservatively and observed for 12 hrs. But she was found to be deteriorating with progressive symptoms of increasing abdominal distension. Patient was planned for emergency exploratory laparotomy as no improvement was seen with a trial of conservative treatment and patient had already reported very late, i.e. after 3 days of duration. On laparotomy we found that distal ileum, caecum, appendix and ascending colon were gangrenous (Figure 2, 3, 4). Hence, we made an intra-op diagnosis of Caecal volvulus. Limited right hemicolectomy was done for gangrenous bowel and double barrel stoma was made as the general condition and nutrition of the patient was poor. Post-operative period was uneventful. Patient was started orally on 5 th post-operative day and discharged on 7 th post-operative day. Stoma reversal was done after 3 months.

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“…However, Katoh et al [6] were of the view that patients' age at the presentation may be affected by cultural and dietary influences. Pousada [7] considered to be an entity common to elderly age group with personal habits such as alcoholism as a risk factor. In present case, no relevant personal history of alcohol or any other addiction was recorded.…”

Section: Discussionmentioning

confidence: 99%