Cecal bascule as a cause of postoperative nausea and abdominal pain

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

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.

Cecal bascule - A rare cause of cecal volvulus after cesarean section

Introduction and importance

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.

Case presentation

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.

Discussion

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.

Conclusion

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.

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The importance of clinical diagnosis as well as prompt imaging in the post-natal patient with obstructive symptoms.

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A right hemicolectomy is the gold standard in the treatment, whereas a cecopexy or cecostomy tube can be used in unstable patients.

Cecal Volvulus Resolved Spontaneously

Cecal volvulus is an uncommon cause of colonic obstruction. First-line treatment for cecal volvulus is surgery, as nonoperative management is rarely achievable. We herein report an extremely rare case of a patient with spontaneously resolved cecal volvulus; no recurrence occurred without elective surgery. A 47-year-old woman presented with acute lower abdominal pain. She was misdiagnosed with small bowel obstruction and treated conservatively. A few hours later, she was correctly diagnosed with cecal volvulus. Subsequently, her symptoms and computed tomography findings of cecal volvulus completely disappeared. She refused elective surgery, but no recurrence occurred during five months of follow-up.

Synchronous Volvulus of the Transverse Colon and Cecum Associated with Scleroderma and Lupus

Colonic volvulus may infrequently occur in the transverse colon, and synchronous double volvulus is a rarely reported phenomenon in the literature. Additionally, intestinal volvulus is a rare but serious complication that has been reported in scleroderma and systemic lupus erythematosus (SLE) patients. We report a 26-year-old patient with a history of scleroderma-SLE overlap syndrome who presented with an acute abdomen. CT imaging revealed a transverse colon volvulus and a cecal bascule (cecal volvulus). To our knowledge, this is the first reported case of synchronous double volvulus of the transverse colon and cecum. Additionally, this is the second reported case of transverse colon volvulus occurring in a patient with scleroderma and the first case in a patient with scleroderma-SLE overlap syndrome.