Bakshi C, Pereira X, Massad N, Lima DL, Peskin-Stolze M, Malcher F. Cecal bascule - A rare cause of cecal volvulus after cesarean section.
Int J Surg Case Rep 2021;
85:106168. [PMID:
34247120 PMCID:
PMC8278416 DOI:
10.1016/j.ijscr.2021.106168]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 06/16/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022] Open
Abstract
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.
Any patient with a redundant cecum who undergoes delivery could potentially be at risk of developing a cecal bascule.
The importance of clinical diagnosis as well as prompt imaging in the post-natal patient with obstructive symptoms.
A right hemicolectomy is the gold standard in the treatment, whereas a cecopexy or cecostomy tube can be used in unstable patients.
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