Gastrografin Enema to the Rescue of the Glorious Cecal Bascule

A 74-year-old woman with a history of gastroesophageal reflux disease, hiatal hernia, Barrett's esophagus, chronic obstructive pulmonary disease, and chronic constipation was hospitalized for community-acquired pneumonia. During her hospitalization, she developed progressive lower abdominal discomfort and reported no bowel movement for 8 days. Conservative measures, including oral laxatives, enemas, and manual disimpaction, were unsuccessful, prompting gastroenterology consultation. Imaging revealed colonic pseudo-obstruction with a markedly dilated cecum, suggestive of a type III cecal bascule-a rare upward folding of the cecum without torsion. Owing to her clinical stability, absence of peritoneal signs, and lack of ischemia on imaging, a nonsurgical approach was pursued. The patient was treated with a Gastrografin enema, resulting in immediate decompression and clinical improvement. This case contributes to emerging literature supporting conservative management of cecal bascule in select patients and emphasizes the importance of careful patient selection.