Cecal bascule causing distal small bowel obstruction: The first documented case report from Africa.

INTRODUCTION

A cecal bascule is a rare variant of a cecal volvulus, which is characterized by an anterior and superior bending of the cecum. It represents an unusual cause of bowel obstruction.

CASE PRESENTATION: A 40-year-old male presented with a 3-day history of crampy periumbilical abdominal pain, bilious vomiting, inability to pass feces and flatus, and progressive abdominal distention. Physical examination revealed stable vital signs except for tachycardia, along with features of viable small bowel obstruction on abdominal examination. An abdominal X-ray revealed distended small bowel loops and multiple air-fluid levels with a dilated cecum in the right lumbar region of the abdomen. Cecal bascule was identified on a midline laparotomy and was managed with right hemicolectomy. The postoperative course and the follow-ups were uneventful.

DISCUSSION: Cecal bascule is commonly seen in patients with a mobile cecum. In addition, adhesion of the anterior cecum to the anterior surface of the ascending colon is a commonly implicated etiological factor. With a competent ileocecal valve, cecal bascule may progress to closed-loop obstruction, potentially leading to ischemia, or perforation. Untreated cecal bascule has a high mortality rate, and conservative treatment fails in approximately 95 % of the cases. Therefore, the mainstay of treatment is resection of the cecum or right hemicolectomy with a near-zero recurrence rate.

CONCLUSIONS

In patients presenting with recurrent or persistent abdominal pain and suggestive radiological findings, cecal bascule should be considered in the differential diagnosis, especially after excluding the common causes. The majority of these patients need surgical intervention.