Caecal bascule: a case series and literature review
Jin-Soo Park1, Kheng-Seong Ng1, Christopher J Young1,2
1Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Insights
Caecal bascule, a rare bowel obstruction, requires high suspicion for prompt diagnosis. Surgical resection is the recommended treatment for this uncommon condition.
Area of Science:
- Gastroenterology
- Surgical Pathology
Background:
- Caecal bascule is a rare cause of bowel obstruction, presenting as an unusual variant of volvulus.
- Diagnosis is often delayed due to its rarity and obscure presentation.
Purpose of the Study:
- To present the diagnostic and management experience of caecal bascule at an Australian tertiary-referral hospital.
- To review existing literature to increase awareness of this uncommon condition.
Main Methods:
- Retrospective review of medical records for patients diagnosed with caecal bascule between 2001 and 2016.
- Comprehensive literature search of PubMed and Medline databases for reported cases.
Main Results:
- Four patients diagnosed with caecal bascule presented with abdominal pain, distension, and vomiting.
- Computed tomography aided diagnosis in three cases; all required laparotomy and right hemicolectomy.
- No mortality was observed; median hospital stay was 15.5 days.
Conclusions:
- A high index of suspicion is crucial for timely diagnosis and management of caecal bascule.
- Laparoscopic cholecystectomy may be a contributing factor to caecal bascule.
- Surgical resection is the recommended definitive treatment, consistent with literature findings.
Background:
Caecal bascule is a rare condition characterized by the inferior pole of the caecum folding on a horizontal axis antero-superiorly towards the ascending colon, potentially causing obstruction. An unusual variant of volvulus, diagnosis is challenging due to its obscurity. We present the experience of an Australian tertiary-referral hospital with the diagnosis/management of caecal bascule, and review cases reported in the literature to raise awareness of this uncommon diagnosis.
Methods:
Medical records of patients diagnosed with caecal bascule during 2001-2016 were reviewed. Data relating to their presentation, investigations, management and outcomes were obtained. A literature search was conducted through PubMed and Medline databases.
Results:
Caecal bascule was diagnosed in four patients (median age: 60.5 (range: 48-75) years, two females). Patients presented with abdominal pain (4/4), distension (3/4), vomiting (3/4) and confusion (1/4) over a 1- to 4-day period. Computed tomography identified caecal displacement in three cases, and bascule was diagnosed at laparotomy in all cases. All patients underwent right hemicolectomy, with primary ileo-colic anastomosis in three cases and formation of Abcarian stoma in one case. Median length of stay was 15.5 days (range: 10-24), with no mortality. Fifteen cases of caecal bascule have been reported in the literature to date, with authors suggesting resection as definitive treatment.
Conclusion:
Correct diagnosis of caecal bascule requires a high index of suspicion and avoids delay of appropriate management. Recent operation, particularly laparoscopic cholecystectomy, may be contributing factors. Resection is recommended, a sentiment echoed by reported cases in the literature.
