BACKGROUND: Caecal bascule is an infrequent type of caecal volvulus. It appears when the caecum folds upon itself, causing an intestinal obstruction. It is usually diagnosed using imaging techniques or intra-operatively. A constrictive band related to previous abdominal surgery is frequently present, and acts as an inflexion point that results in a closed loop obstruction of the ascending colon. It has been reported in young women and in elderly hospitalised patients. The aim of this report is to describe the clinical features, diagnostic difficulties, and management strategies of this unusual entity. CLINICAL CASE: An 83-year-old male with concurrent acute neurological illness presented with history of intestinal obstruction. Because of a previous right nephrectomy, postoperative adhesions were suspected and conservative treatment initiated. As no improvement was seen, a computed tomography scan was obtained. Abdominal tomography showed an intestinal obstruction and a caecal bascule with vascular compromise. A right colectomy was performed. CONCLUSIONS: Caecal bascule is a rare cause of intestinal obstruction. The suspicion should be heightened when caecal ectopic dilation is present. Computed tomography scan is the preferred imaging technique, especially for ill patients. Right colectomy and primary anastomosis is the most appropriate surgical technique. Awareness of this entity can prevent the high morbidity and mortality rates of this condition.
BACKGROUND: Caecal bascule is an infrequent type of caecal volvulus. It appears when the caecum folds upon itself, causing an intestinal obstruction. It is usually diagnosed using imaging techniques or intra-operatively. A constrictive band related to previous abdominal surgery is frequently present, and acts as an inflexion point that results in a closed loop obstruction of the ascending colon. It has been reported in young women and in elderly hospitalised patients. The aim of this report is to describe the clinical features, diagnostic difficulties, and management strategies of this unusual entity. CLINICAL CASE: An 83-year-old male with concurrent acute neurological illness presented with history of intestinal obstruction. Because of a previous right nephrectomy, postoperative adhesions were suspected and conservative treatment initiated. As no improvement was seen, a computed tomography scan was obtained. Abdominal tomography showed an intestinal obstruction and a caecal bascule with vascular compromise. A right colectomy was performed. CONCLUSIONS: Caecal bascule is a rare cause of intestinal obstruction. The suspicion should be heightened when caecal ectopic dilation is present. Computed tomography scan is the preferred imaging technique, especially for ill patients. Right colectomy and primary anastomosis is the most appropriate surgical technique. Awareness of this entity can prevent the high morbidity and mortality rates of this condition.