Cecal bascule

Case contributed by Dr Paul Heyworth

Presentation

Day 3 post left iliofemoral bypass surgery, reduced food tolerance. ?ileus.

Patient Data

Age: 70
Gender: Male
X-ray

NJ tube again noted within the duodenum. NG tube appropriately positioned within the stomach. Right common iliac stent and surgical clips noted.

Small bowel distension, with a maximal diameter of 3.9 cm. The cecum is distended with a maximal diameter of 11.5 cm. No evidence of pneumatosis coli or subphrenic free gas. Distal to the dilated cecum there is collapse of the large bowel. Appearances are suggestive of developing obstruction at the level of cecum, possibly a volvulus.

CT

Patient proceeded to CT abdo/pelvis

Nasogastric tube is noted curled within the stomach, with tip in the first part the duodenum, and suggest retraction. Indwelling urinary catheter in situ.

The cecum is folded anteriorly and oriented superiorly in the right abdomen. There is no high-grade transition point, noting fecal content is contiguous distally into the ascending colon. There is borderline dilatation of the small bowel measuring up to 3 cm. No evidence of pneumatosis, portal venous gas or pneumoperitoneum. No intra-abdominal free fluid.

Left iliac-femoral bypass graft noted, and appears patent. Associated small retroperitoneal hematoma along the left iliac artery and left pelvic sidewall. Bilateral native iliac artery stents noted. Moderate narrowing of the distal right external iliac artery.

Case Discussion

A cecal bascule is a form of cecal volvulus, whereby the cecum folds anteriorly/anteromedially on itself without a torsion component.

The x-ray above shows the classical appearance of dilated cecum and small bowel with collapsed large bowel distally to the cecum. This was confirmed on CT.

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Case information

rID: 61096
Published: 16th Jun 2018
Last edited: 24th Sep 2019
Inclusion in quiz mode: Included

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