Caecal bascule: a case series and literature review

Abstract

Background: Caecal bascule is a rare condition characterized by the inferior pole of the caecum folding on a horizontal axis antero-superiorly towards the ascending colon, potentially causing obstruction. An unusual variant of volvulus, diagnosis is challenging due to its obscurity. We present the experience of an Australian tertiary-referral hospital with the diagnosis/management of caecal bascule, and review cases reported in the literature to raise awareness of this uncommon diagnosis.

Methods: Medical records of patients diagnosed with caecal bascule during 2001-2016 were reviewed. Data relating to their presentation, investigations, management and outcomes were obtained. A literature search was conducted through PubMed and Medline databases.

Results: Caecal bascule was diagnosed in four patients (median age: 60.5 (range: 48-75) years, two females). Patients presented with abdominal pain (4/4), distension (3/4), vomiting (3/4) and confusion (1/4) over a 1- to 4-day period. Computed tomography identified caecal displacement in three cases, and bascule was diagnosed at laparotomy in all cases. All patients underwent right hemicolectomy, with primary ileo-colic anastomosis in three cases and formation of Abcarian stoma in one case. Median length of stay was 15.5 days (range: 10-24), with no mortality. Fifteen cases of caecal bascule have been reported in the literature to date, with authors suggesting resection as definitive treatment.

Conclusion: Correct diagnosis of caecal bascule requires a high index of suspicion and avoids delay of appropriate management. Recent operation, particularly laparoscopic cholecystectomy, may be contributing factors. Resection is recommended, a sentiment echoed by reported cases in the literature.

Keywords: caecal bascule; caecal diseases; caecal volvulus; intestinal obstruction; intestinal volvulus.