Bascule caecal volvulus: a rare cause of intestinal obstruction

Abstract

Caecal volvulus is a rare cause of intestinal obstruction, with the bascule subtype accounting for <10% of all cases of caecal volvulus. It is associated with significant morbidity and mortality if left undiagnosed. We present the case of a 58-year-old female who presented to our surgical department with symptoms of intestinal obstruction. She had various radiological investigations, which supported the diagnosis of a caecal volvulus of the bascule subtype. She was subsequently managed surgically and had a right hemicolectomy and ileocolic anastomosis. Her recovery was uneventful and she was discharged within 1 week of having her operation. Fortunately, caecal volvulus of the bascule subtype is rarely encountered; however, clinicians need to be aware of its presentation and subsequent management options so that clinical outcomes are improved.

Figure 1:

Erect chest radiograph, showing a large hiatus hernia and large loop of bowel elevating the right hemidiaphragm.

Figure 2:

CT coronal section demonstrating caecum medially displacing the liver and causing an upward pressure on the right hemidiaphragm.

Figure 3:

A large bowel contrast study showing the flow of contrast from the collapsed transverse colon into the dilated, upwardly displaced caecum.

Figure 4:

Coronal section of contrast-enhanced CT demonstrating contrast filling upwardly displaced caecum.

Figure 5:

Axial section of contrast-enhanced CT demonstrating ‘whirl sign’ at the point of volvulus.

Figure 6:

Freely mobile, distended caecum found on opening.