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Case Reports
. 2021 Apr 14;16(6):1469-1472.
doi: 10.1016/j.radcr.2021.02.038. eCollection 2021 Jun.

Cecal bascule with secondary gastric outlet obstruction in addition to a large bowel closed obstruction: A case report

Francisco J González Sánchez  1 , Raúl Pellón Daben  1 , Mercedes Acebo García  1 , Sara Sanchez Bernal  1 , Juan Crespo Del Pozo  1 , Carmen González-Carreró Sixto  1
Affiliations
Case Reports

Cecal bascule with secondary gastric outlet obstruction in addition to a large bowel closed obstruction: A case report

Francisco J González Sánchez et al. Radiol Case Rep. .

Erratum in

Abstract

We present a case of cecal bascule in a 60-year-old woman with abdominal pain and vomiting. Imaging tests revealed a cecal bascule causing mechanic obstruction of the stomach. Besides a small bowel dilatation was not seen, the distended cecum was extrinsically obstructing the antrum and therefore, the gastric outlet. Cecal bascule is a form of cecal volvulus without the axial twisted component. The cecum folds anterior or anteromedially on itself and, because of a valve mechanism, becomes distended. The pressure increases and it begins to compromise arterial blood flow so life-threatening complications, such as bowel ischemia and infarction can occur. Prompt diagnosis is therefore crucial and plain radiographs and computed tomography are the preferred imaging techniques for this purpose.

Keywords: Acute abdomen; Diagnostic X-ray; Intestinal obstruction; Intestinal volvulus; Multidetector computed tomography.

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Figures

Fig 1
Fig. 1
Plain X-ray of the abdomen. Severe dilatated viscus located at the epigastrium displacing the stomach laterally. Bowel distention in the lower abdomen.
Fig 2
Fig. 2
Contrast enhanced abdominal CT. Distended mispositioned cecum at the epigastrium (*) conditioning an extrinsic compression of the gastric antrum that appears collapsed (arrowhead). Secondary severe dilatation of the gastric chamber, with surrounding free peritoneal fluid. Absence of the cecum and ascending colon in right hemiabdomen, which is occupied by small bowel dilatated loops . Remaining large bowel and jejunal loops appear collapsed.
Fig 3
Fig. 3
Contrast enhanced abdominal CT. Oblique coronal view. Markedly dilatated cecum and part of the ascending colon displaced upwards and medially to the epigastrium (*). Adjacent to the medial wall of this loop an image of vascular crossover is observed with sharped narrowing of the dragged intestinal loops (arrow).
Fig 4
Fig. 4
Contrast enhanced abdominal CT. Sagittal view. Distended cecum (*) at epigastrium causes an anterior extrinsic compression of the antrum (↓). Secondary fluid-filled distended stomach (S).
Fig 5
Fig. 5
Contrast enhanced abdominal CT. Coronal MPR and volume reformations. Closed loop obstruction features. A dilatated cecum is seen, fold over the ascending colon and located at the epigastrium, fixed on its lateral aspect, where a change in caliber is appreciated (→). No “whirlpool sign” is appreciated. Findings consistent with a cecal bascule.
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