Diagnostic Challenges in Cecal Bascule: A Case Report

Cecal bascule is a rare subtype of cecal volvulus characterized by anterior folding of the cecum without axial torsion. Its nonspecific presentation often makes early diagnosis challenging, and delayed recognition may lead to bowel ischemia, perforation, or closed-loop obstruction. We report the case of a 77-year-old female patient with type two diabetes mellitus who presented with five days of right-sided abdominal pain, progressive abdominal distension, constipation, vomiting, and anorexia. Laboratory investigations showed leukocytosis, markedly elevated C-reactive protein, mild lactic acidosis, hypokalemia, and hyponatremia. Contrast-enhanced computed tomography (CT) demonstrated a distended anteriorly displaced cecum with findings suggestive of incomplete cecal volvulus, favoring cecal bascule. Emergency surgical exploration was performed, initially planned as diagnostic laparoscopy but converted to midline laparotomy due to marked colonic distension. Intraoperatively, the cecum, ascending colon, and transverse colon were severely dilated, with the cecum folded anteriorly and a constricting band causing obstruction. The obstruction was relieved by mobilization of the cecum and ascending colon, with no bowel resection required. The patient recovered postoperatively and was discharged in stable condition. This case highlights the importance of considering cecal bascule in patients presenting with acute large bowel obstruction and emphasizes the role of early CT diagnosis and timely surgical intervention.