Caecal bascule following lung transplantation

Area of Science:

• Gastroenterology
• Transplant Surgery
• Surgical Pathology

Background:

• Caecal bascule is a rare cause of intestinal obstruction where the cecum folds onto the ascending colon.
• Post-operative paralytic ileus is common after lung transplantation and can present with abdominal distention.
• Differentiating between paralytic ileus and surgically correctable conditions like caecal bascule is critical in immunosuppressed patients.

Observation:

• A case of caecal bascule requiring right hemicolectomy following lung transplantation is presented.
• The condition was initially misdiagnosed as post-operative paralytic ileus.
• The patient was heavily immunosuppressed, and abdominal distention is a common post-transplant symptom.

Findings:

• Caecal bascule can mimic paralytic ileus, necessitating a high index of suspicion for surgical intervention.
• Right hemicolectomy was successfully performed to relieve the intestinal obstruction.
• Management involved careful consideration of surgical risks in an immunosuppressed patient.

Implications:

• Early recognition and surgical management of caecal bascule can be life-saving in post-lung transplant patients.
• This case underscores the importance of considering surgically correctable causes of abdominal obstruction beyond typical post-operative ileus.
• Optimizing nutrition and immunosuppression management is crucial during surgical recovery in transplant recipients.