Cecal bascule is a rare form of a cecal volvulus characterized by an anterior and superiorly displaced cecum in turn causing compression of the ascending colon that can result in a large bowel obstruction. We report a case of cecal bascule in a newly postpartum patient, with emphasis on clinical presentation, radiologic findings and treatment.

A 37-year-old female who underwent an uncomplicated c-section and bilateral salpingectomy developed severe abdominal pain, vomiting, and peritonitis 12 h after surgery. A computerized tomography of the abdomen and pelvis revealed a dilated and superiorly displaced cecum. The diagnosis of cecal bascule was confirmed intraoperatively and a right hemicolectomy was performed. The patient recovered appropriately and was discharged on postoperative day six.

Cecal bascule is the rarest form of cecal volvulus. In the context of obstetrics and gynecology, it has mostly been mentioned perioperatively after cesarean, but was also reported in an antepartum patient. It usually occurs in patients with redundant or mobile cecum, which is a result of incomplete fixation of the cecum to the retroperitoneum during embryogenesis. Other risk factors include recent surgery, previous abdominal surgery, ileus, chronic constipation, and distal colonic obstruction. An association has also been shown with pregnancy or the postpartum abdomen and is hypothesized to be due to mass effect.

Cecal bascule is a serious entity requiring a high index of suspicion and warranting greater awareness in the post-natal patient. Clinical diagnosis, prompt imaging, and surgery are important to avoid bowel ischemia and perforation.

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Any patient with a redundant cecum who undergoes delivery could potentially be at risk of developing a cecal bascule.

• Case report
• Gastrointestinal disorders
• Postpartum care
• Surgery

• Case report
• Cecal bascule
• Cecal volvulus
• Cecectomy
• Laparotomy

Cecal bascule is a form of volvulus resulting from upward and anterior cecal folding, and accounts for 0.01% of adult large bowel obstructions. With a competent ileocecal valve, cecal bascule may progress to closed loop obstruction, ischemia, gangrene, or perforation. Failure to treat cecal bascule has a mortality of 50%. Nonoperative management includes nasogastric and colonoscopic decompression, with a 95% failure rate. The gold standard is right hemicolectomy with a near nonexistent recurrence rate. Severe gastrointestinal complications following cardiothoracic surgery may lead to increased morbidity, length of stay, and mortality. Here, we present the first reported case of cecal bascule following cardiac surgery.

• Abdominal pain
• cecal bascule
• colon dilatation
• coronary artery bypass
• coronary artery disease
• intestinal volvulus

Bowel obstructions can have a variety of causes, including impacted feces, adhesions, volvulus, non-internal hernias, and in rare cases internal hernias. We report a 63-year-old woman who presented to the emergency department with severe abdominal pain, nausea, vomiting, and obstructive symptoms that had started 12 hours earlier. A computed tomographic scan of the abdomen and pelvis showed a right internal hernia with a cecal bascule traversing through the foramen of Winslow, concerning for a closed-loop obstruction. The patient underwent an exploratory laparotomy with cecal bascule reduction and cecopexy. Given the increased mortality risk if undiagnosed, it is important to remain aware of internal hernias. Patient outcomes are markedly improved with early diagnosis and surgical intervention.

• Colorectal Surgery
• Hernia
• Intestinal Obstruction
• Laparotomy

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.

• Cecal basule
• Cecal volvulus

This report is of a rare case involving a 27-year-old female who presented to the hospital with the pathological couplet of colocolic intussusception and cecal bascule causing bowel obstruction. Up to the time of presentation to the hospital, this patient had not undergone a full investigation for a known iron deficiency, anemia. Subsequently, during the emergency admission and after having an operative surgical procedure, the patient was found to have both a congenitally malpositioned cecum and a benign colonic polyp-forming condition. The pertinent issues about this unusual case to be highlighted are its ambiguous clinical presentation; uncommon gender and age group for either condition; the simultaneous occurrence of dual anatomical anomalies; and the uncommon benign etiology of causes of bowel obstruction in adults.

• caecal bascule
• colorectal surgery
• intussusception
• radiology

• caecal bascule
• caecal diseases
• caecal volvulus
• intestinal obstruction
• intestinal volvulus

• Aged
• Australia
• Cecal Diseases/diagnosis
• Cecal Diseases/etiology
• Cecal Diseases/surgery
• Female
• Humans
• Intestinal Volvulus/diagnosis
• Intestinal Volvulus/etiology
• Intestinal Volvulus/surgery
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors

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.

• abdominal radiography
• computed tomography
• intestinal obstruction
• malrotation
• volvulus

Cecal bascule is a rare cause of bowel obstruction in which a mobile cecum folds anteriorly and superiorly over the ascending colon. Herein, we present the first case of internal herniation of a cecal bascule into the lesser sac through the foramen of winslow, aiming at discussing radiological findings, differential diagnosis, and surgical management of this uncommon condition. A 75-year-old female presented to the emergency room with an 18-h history of sudden onset sharp, progressively worsening abdominal pain associated with vomiting. Physical exam revealed abdominal distention and epigastric tenderness while initial laboratory tests were unremarkable. Computed tomography of her abdomen and pelvis showed a loop of distended colon within lesser sac without signs of bowel ischemia or perforation. On exploratory laparotomy, a cecal bascule was found herniating into lesser sac via foramen of winslow. Upon reduction, the cecum appeared viable therefore a cecopexy was performed without bowel resection. Unlike cecal volvulus, cecal bascule consists of no axial rotation of the bowel with no mesenteric vascular compromise and therefore ischemia would only occur from intraluminal tension or extraluminal compression from the borders of foramen of winslow. The management of internal herniation of a cecal bascule is always surgical including anatomic resection or cecopexy.

• Cecal
• Bascule
• Hernia
• Internal
• Foramen
• Winslow

• bowel
• ovary
• testicle
• torsion
• volvulus

• Cecum
• Inflammation
• Multidetector computed tomography
• Neoplasm
• Vascular

• Cecal Diseases/diagnosis
• Cecal Diseases/etiology
• Child, Preschool
• Female
• Fundoplication/methods
• Gastroesophageal Reflux/surgery
• Humans
• Intestinal Obstruction/diagnosis
• Intestinal Obstruction/etiology
• Laparoscopy
• Postoperative Complications/diagnosis

• Abdominal Pain/etiology
• Diagnosis, Differential
• Diverticulum, Colon/complications
• Diverticulum, Colon/pathology
• Female
• Humans
• Middle Aged
• Sigmoid Diseases/complications
• Sigmoid Diseases/pathology
• Weight Loss

• Barium Sulfate/administration & dosage
• Barium Sulfate/therapeutic use
• Cecal Diseases/therapy
• Enema
• Female
• Humans
• Intestinal Obstruction/therapy
• Middle Aged

• Aged
• Cecal Diseases/diagnostic imaging
• Colon/abnormalities
• Colon/diagnostic imaging
• Colon/embryology
• Colon, Sigmoid/abnormalities
• Colon, Sigmoid/diagnostic imaging
• Female
• Humans
• Intestinal Obstruction/diagnostic imaging
• Mesocolon/abnormalities
• Mesocolon/diagnostic imaging
• Middle Aged
• Peritoneum/diagnostic imaging
• Pregnancy
• Radiography

• Adult
• Aged
• Colonic Diseases/diagnostic imaging
• Female
• Humans
• Intestinal Obstruction/diagnostic imaging
• Male
• Middle Aged
• Radiography