Presentation
Progressive constipation, nausea, vomiting, increasing abdominal distention and a failure to pass flatus.
Patient Data
CT abdomen with contrast
Extremely distended cecum that occupies an ectopic site in the left upper quadrant with air and feces within it, but no mesenteric or vascular torsion. CT did not show any signs of ischemia. There are few air fluid levels the distal ileum loops with "fecal sign". There is also a heterogeneously enhancing 3 cm-diameter hypervascular right renal mass.
Xray abdomen with oral positive contrast
Markedly distended cecum with air-fluid level, that occupies the central region of the abdomen. After positive oral contrast ileus colic transit is present.
Xray abdomen
Reduced distension and transverse rotation of the cecum beyond the midline of the upper abdomen. The remaining colon is normally distended by gas up to the rectum.
Case Discussion
With a cecal bascule the cecum folds cephalad and anteromedially over the ascending colon, forming a ‘flap-valve’ occlusion in the transverse plane. With a competent ileocecal valve, a cecal bascule progresses to a closed loop obstruction as the cecum is unable to decompress. The bowel distends with gas and bacteria, becomes ischemic and may become perforated or gangrenous. The patient most likely considering his pre-existing history of intermittent constipation and bloating had spontaneous resolution after passage of flatus. The patient was discharged.
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