Robin Osofsky, MD, Heesung Park, BS, Sarah Popek, MD. University of New Mexico
Intro: Cecal bascule is a subtype of cecal volvulus characterized by anterior fold of the cecum into mid abdomen without any torsion, resulting in a closed loop obstruction. The infrequency with which it is encountered makes cecum bascule a challenging subject to study.
Case Report: A 53-year-old male with past surgical history of childhood open appendectomy presented to the emergency department with acute onset of epigastric abdominal pain 3 days after a bicycle accident. He was diagnosed with multiple rib fractures. He was recovering at home and developed acute onset of severe abdominal pain and distention which worsened throughout the day, fever, and nausea without emesis.
Upon presentation to the emergency department, the patient’s vital signs were stable, and lab values were within normal limits. His abdominal pain resolved with intravenous hydromorphone. The patient underwent CT of abdomen and pelvis with intravenous contrast to rule out delayed presentation of trauma-related injury. This revealed an abnormally rotated cecum in the upper mid abdomen with dilation of 12 cm, concerning for cecal bascule. He was admitted for observation and was treated non-operatively. The following day, the patient had no abdominal pain, was tolerating a solid diet, passing flatus and stool, and he was discharged with outpatient follow-up for cecal bascule.
Colonoscopy was performed 2 weeks after discharge, which was normal aside from a large redundant cecum. The patient was offered options of non-operative management, cecectomy, and right hemicolectomy, and elected robotic-assisted right hemicolectomy with ileocolic anastomosis.
Four months after initial presentation, the patient underwent elective robotic assisted right hemicolectomy. Intraoperatively, the cecum was noted to be extremely mobile and redundant with no other gross abnormalities. The patient had no postoperative complications and was discharged on postoperative day one. Pathology of the resected colon and terminal ileum was unremarkable. At follow-up four weeks later, the patient reported having returned to work, resuming his activities of daily living, and with normal appetite and return of regular bowel habits.
Discussion: This case illustrates the potential for trauma inducing cecal bascule in a patient with a history of appendectomy. Although rare, cecal bascule should be considered as a differential diagnosis in trauma patients with cecal distention in order to provide appropriate counseling and treatment.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94639
Program Number: P370
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster