Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2014 Dec 16;2(12):903-6.
doi: 10.12998/wjcc.v2.i12.903.

Cecal bascule herniation into the lesser sac

Tafadzwa Makarawo  1 , Francisco Igor Macedo  1 , Michael J Jacobs  1
Affiliations
Case Reports

Cecal bascule herniation into the lesser sac

Tafadzwa Makarawo et al. World J Clin Cases. .

Abstract

Cecal bascule is a rare cause of bowel obstruction in which a mobile cecum folds anteriorly and superiorly over the ascending colon. Herein, we present the first case of internal herniation of a cecal bascule into the lesser sac through the foramen of winslow, aiming at discussing radiological findings, differential diagnosis, and surgical management of this uncommon condition. A 75-year-old female presented to the emergency room with an 18-h history of sudden onset sharp, progressively worsening abdominal pain associated with vomiting. Physical exam revealed abdominal distention and epigastric tenderness while initial laboratory tests were unremarkable. Computed tomography of her abdomen and pelvis showed a loop of distended colon within lesser sac without signs of bowel ischemia or perforation. On exploratory laparotomy, a cecal bascule was found herniating into lesser sac via foramen of winslow. Upon reduction, the cecum appeared viable therefore a cecopexy was performed without bowel resection. Unlike cecal volvulus, cecal bascule consists of no axial rotation of the bowel with no mesenteric vascular compromise and therefore ischemia would only occur from intraluminal tension or extraluminal compression from the borders of foramen of winslow. The management of internal herniation of a cecal bascule is always surgical including anatomic resection or cecopexy.

Keywords: Bascule; Cecal; Foramen; Hernia; Internal; Winslow.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Computed tomography of abdomen and pelvis showing a loop of distended colon within lesser sac without bowel ischemia or perforation. Radiological features include: (1) the cecum herniated (C) into the lesser sac behind the stomach (S) (A and B); (2) the presence of mesentery (white arrow) between the portal vein and inferior vena cava (A); and (3) the presence of gas or fluid in the lesser sac with its ‘beak’ directed toward the foramen of winslow (B).
Figure 2
Figure 2
Intraoperatively, a cecal bascule was found herniating into lesser sac via foramen of winslow (A). Upon reduction, the cecum appeared viable (B).
See this image and copyright information in PMC

References

    1. Bobroff LM, Messinger NH, Subbarao K, Beneventano TC. The cecal bascule. Am J Roentgenol Radium Ther Nucl Med. 1972;115:249–252. - PubMed
    1. Consorti ET, Liu TH. Diagnosis and treatment of caecal volvulus. Postgrad Med J. 2005;81:772–776. - PMC - PubMed
    1. Madiba TE, Thomson SR. The management of cecal volvulus. Dis Colon Rectum. 2002;45:264–267. - PubMed
    1. Lazar DA, Cohen SA, Evora DK, Losasso BE, Bickler SW. Cecal bascule in a child: an unusual cause of postoperative bowel obstruction. J Pediatr Surg. 2012;47:609–611. - PubMed
    1. Rozycki GS. Special feature: Image of the month. Cecal bascule. Arch Surg. 2001;136:835–836. - PubMed

Publication types

LinkOut - more resources