Caecal bascule following lung transplantation

Caecal bascule refers to a rare condition wherein the caecum folds upon the ascending colon causing intestinal obstruction. We describe a case report of caecal bascule following lung transplantation which required right hemicolectomy. It was initially thought to be due to post-operative paralytic ileus which is, not uncommonly, seen following lung transplantation. While most cases of paralytic ileus respond to conservative measures, it is important to maintain a close watch-keeping in mind a high degree of suspicion for possible surgically correctable causes, which can be a lifesaving intervention. The clinical dilemma in subjecting a heavily immunosuppressed patient, soon after lung transplantation (where painless abdominal distention is not uncommon), to a major abdominal surgery in the background of minimal clinical signs of acute abdomen is discussed. The thought process behind the surgical strategy, including the pros and cons of various surgical options and the management of nutrition and immunosuppression in this patient, is elaborated.