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Caecal volvulus is a rare cause of intestinal obstruction, with the bascule subtype accounting for <10% of all cases of caecal volvulus. It is associated with significant morbidity and mortality if left undiagnosed. We present the case of a 58-year-old female who presented to our surgical department with symptoms of intestinal obstruction. She had...
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Citations
... In contrast, a cecal bascule does not have an axial twist. Hence, vascular occlusion and ischemic changes are rare [2,15]. A cecal bascule can still develop gangrene from overdistention causing constriction of the venous and capillary network [3]. ...
... The rarity of a cecal bascule may be that the cecum f lops back into anatomical position causing intermittent subacute obstructions [15]. This is evident in our patient as she had colicky pain in the right side of her abdomen during the first hospital day, before developing obstructive symptoms. ...
A 36-year-old female at 36 weeks' gestation presented with right upper quadrant abdominal pain. She had no prior surgeries. Her pregnancy had been uncomplicated up until her presentation. Abdominal ultrasound was negative for cholecystitis or cholelithiasis, and the appendix was not visualized. During the second day of her hospital course, an abdominal magnetic resonance imaging (MRI) was performed revealing dilated small intestine with air-fluid levels and an inverted-appearing, prominent cecum. She was urgently taken to the operating room for cesarean section followed by abdominal exploration. After delivery of the child, a cecal bascule was found, with a severely distended cecum. To our knowledge, this is the first report of a cecal bascule diagnosed by MRI, and the first diagnosis of cecal bascule in a pregnant patient requiring surgical intervention. We discuss the pathophysiology, diagnosis and treatment of cecal bascule and review the current literature of reported cases.
... twisting. 5,6 Our patient had type II cecal volvulus. ...
Unusual case of caecal volvolus
... An average age of 53 years has been reported in the West, 33 years in India [4] and 52 years in Kenya [5]. The disease mainly affects female patients however, there is no predisposition to sex [2,6,7]. ...
... There are three types of caecal volvulus that have been described by Ramsingh J et al. [6]: ...
Caecal volvulus is a rare cause of adult bowel obstruction characterised by torsion of the caecum and terminal ileum around the mesentery. Caecal volvulus happens to be the second most common form of large bowel volvulus after sigmoid volvulus. The goal of this review is to raise surgeon awareness of this type of bowel obstruction through a patient case discussion and treatment strategies for caecal volvulus. A 47 year old gentleman had an emergency laparotomy for large bowel obstruction following preoperative resuscitation. There was axial rotation of the caecum with congestion of the caecum's posterior wall during laparotomy. An end-to-end ileo-transverse anastomosis and right hemicolectomy were performed, and the recovery period was uneventful. The clinical presentation is quite varied and can range from colicky abdominal pain that comes and goes to generalised abdominal pain brought on by intestinal gangrene and sepsis. Caecal volvulus carries a significant mortality rate, particularly if the preoperative diagnosis is delayed. When a strong index of suspicion is taken into account for early diagnosis to avoid intestinal ischaemia and ultimately gangrene and sepsis, this mortality may be decreased.
... An average age of 53 years has been reported in the West, 33 years in India [4] and 52 years in Kenya [5]. The disease mainly affects female patients however, there is no predisposition to sex [2,6,7]. Caecal volvulus happens to be the second most common form of large bowel volvulus after sigmoid volvulus [1]. ...
Introduction: Caecal volvulus is an infrequent cause of adult bowel obstruction which involves torsion involving the caecum and terminal ileum around its mesentery. The aim of this review is to promote the surgeon's awareness of this form of bowel obstruction through a patient case discussion and management strategies for treating caecal volvulus.
Clinical presentation: A 47 year old gentleman had an emergency laparotomy for large bowel obstruction following preoperative resuscitation. At laparotomy there was axial rotation of the caecum with congestion of the posterior wall of the caecum. A right hemicolectomy and an end-to-end ileo-transverse anastomosis was carried out, followed by an uneventful recovery.
Discussion: The clinical presentation is highly variable and ranges from intermittent colicky abdominal pain to generalized abdominal pain due to bowel gangrene and sepsis.
Conclusions: There is a high mortality associated with caecal volvulus especially if there is a delay in the preoperative diagnosis. This mortality may be reduced when a high index of suspicion is considered for early diagnosis to prevent bowel ischaemia and eventual gangrene and sepsis.
Keywords: Caecal volvulus; Pathogenesis; Bowel obstruction; Operative management
... 5 Treatment usually involves urgent surgical intervention as delay may lead to bowel necrosis and perforation. 6 We present the first reported case of cecal bascule in a COVID-19 positive patient. ...
Cecal volvulus is an uncommon cause of acute intestinal obstruction accounting for around 10% of intestinal volvuli. There are three main variants of cecal volvuli including the axial, loop, and bascule types. Diagnosis is confirmed via a computed tomography scan and surgery is the mainstay treatment due to a high risk of morbidity and mortality. Here we report a rare presentation of cecal volvulus in a COVID-19 positive patient that was complicated by an anastomotic leak.
... Caecal bascule only accounts for <10% of all cases of caecal volvulus and involves the folding of the caecum anteriorly over the ascending colon [3]. Given there is less mesenteric rotation, it is less associated with vascular compromise [3]. ...
... Caecal bascule only accounts for <10% of all cases of caecal volvulus and involves the folding of the caecum anteriorly over the ascending colon [3]. Given there is less mesenteric rotation, it is less associated with vascular compromise [3]. ...
Caecal volvulus represents an uncommon acute surgical presentation of bowel obstruction. Familiarity with particular long-term symptoms and pre-disposing factors can help a clinician identify caecal volvulus as a possible diagnosis. There has been a changing vogue of radiological investigation and surgical interventions. We present a summary of these options.
... With no predisposition related to sex, the disease predominantly affects female patients of 40-62 years of age [10]. Sufficient cecal mobility, bascule formation, adhesions from abdominal surgery, chronic constipation, pregnancy or prolonged immobility have been identified to be the leading cause of occurrence of cecal volvulus [11]. ...
... Type 1 and type 2, which involve axial torsion, account for approximately 80% of all cecal volvuli. Cecal bascules account for the remaining 20% of cecal volvuli [10]. The case presenting had type I whereby the cecal volvulus was twisted clockwise on its mesenteric axis with necrosed anterior part of the cecum. ...
Introduction and importance
Cecal volvulus is uncommon cause of intestinal obstruction. It affects the ascending colon and the terminal part of the ileum which are twisted around the mesenteric pedicle.
Case presentation
We report the case of 37-year-old male who underwent emergency laparotomy for intestinal obstruction and found a twisted cecum with ileal knotting and anterior part of cecum necrosed. Resection of cecum and terminal ilium followed by end-to-end anastomosis of ileum to ascending colon were performed.
Clinical discussion
Cecal volvulus remains an uncommon cause of intestinal obstruction with a surgical incidence of 2.8–7.1 cases per year per 1 million people. Delay in diagnosis can lead to complications such as necrosis and perforation of the cecum.
Conclusion
We present a rare case of cecal volvulus in a 37-year-old male with necrosed part of the cecum without perforation. Early diagnosis and management can prevent perforation and reduce morbidity related to the cecal perforation.
... twisting. 5,6 Our patient had type II cecal volvulus. ...
Among acute causes of pain in abdomen and intestinal obstruction cecal volvulus is an
uncommon condition. The clinical presentation is often variable which ranges from non
specific sign and symptoms to severe un-relieving pain often leading to sepsis, perforation
or bowel strangulation. A high index of suspicion is required to diagnose cecal volvulus,
as initial presentation is usually non specific and non critical. We present a patient of cecal
volvulus who underwent right hemicolectomy
... Literature suggests that cecal volvuli usually occur in patients with congenital failure of the fusion of the right colon mesentery to the retroperitoneal structures resulting in increased cecal mobility [1] . Risk factors for developing cecal volvulus include previous abdominal surgery, high fiber intake, and chronic constipation [3] . The exact etiology of our patient's postoperative cecal bascule is unclear, although potentially the anesthesia and pharmacologic agents used in the perioperative period could have affected the autonomic nervous system resulting in an atonic distal colon and proximal hypermobility. ...
Cecal bascule is a unique form of large bowel volvulus in which the cecum folds anterior to the ascending colon and generates a flap valve which impairs cecal emptying and results in cecal dilation [1]. Presenting symptoms include nausea, vomiting, abdominal pain, distension, and constipation. We report a case of a 74-year-old male who developed abdominal pain and nausea after a coronary artery bypass graft surgery. Imaging demonstrated an enlarged cecum measuring up to 17.7 cm as well as upstream small bowel dilation. The patient underwent nasogastric tube and endoscopic decompression, relieving his cecal dilation and symptoms.
... Most cases of large bowel obstruction worldwide are caused by malignancy, with diverticular disease and volvulus causing the small remainder of obstructions. 1 Of the cases of intestinal volvulus, the sigmoid is the most commonly affected portion of the colon. 2 Cecal volvulus accounts for less than 1% of all large bowel obstructions, and a cecal bascule is estimated to occur in only 10% of these cases of cecal volvulus. 1 A review of 561 patients with cecal volvulus demonstrated that this condition commonly presents with symptoms of bowel obstruction -abdominal pain, constipation, nausea and vomiting. ...
... Most cases of large bowel obstruction worldwide are caused by malignancy, with diverticular disease and volvulus causing the small remainder of obstructions. 1 Of the cases of intestinal volvulus, the sigmoid is the most commonly affected portion of the colon. 2 Cecal volvulus accounts for less than 1% of all large bowel obstructions, and a cecal bascule is estimated to occur in only 10% of these cases of cecal volvulus. 1 A review of 561 patients with cecal volvulus demonstrated that this condition commonly presents with symptoms of bowel obstruction -abdominal pain, constipation, nausea and vomiting. 3 Physical exam may reveal abdominal distension, hyperperistalsis, peritoneal signs, an abdominal mass and/or absent bowel sounds. ...
... 3 However, patients with a cecal bascule may only have intermittent signs of obstruction due to periodic flipping of the cecum back into its anatomical position. 1 Many cases of cecal bascule presenting to the emergency department (ED) are missed on initial presentation due to this phenomenon of periodic obstruction. This subtype is thought to strangulate less often as its mesentery is infrequently twisted, but it can still progress to cause intestinal ischemia if not adequately addressed. ...
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.
