A Case of Cecal Bascule Following Clostridioides difficile Colitis

Abstract

Cecal bascule is a rare subtype of cecal volvulus, involving the cecum rotating anteriorly onto the ascending colon. This type of cecal volvulus has no torsion component, allowing it to present uniquely compared to other bowel obstructions. Infections, inflammation, and other colonic conditions can contribute to changes in colonic motility, which may play a role in the development of cecal bascule. This is a case of cecal bascule following a colonic infection by Clostridioides difficile. A 62-year-old Caucasian man, with a past medical history significant for hypertension, nicotine dependence, and alcohol dependence, presented for shortness of breath. After six days in the ICU for treatment of septic shock secondary to multilobar right-sided pneumonia and new-onset atrial fibrillation with rapid ventricular response, the patient was noted to have diarrhea with positive C. difficile polymerase chain reaction (PCR), but with negative enzyme immunoassay (EIA) toxin. After treatment and resolution of C. difficile infection (CDI), an abdominal computed tomography (CT) scan noted new-onset gaseous distension of the cecum. A follow-up abdominal CT scan reported worsening cecal distension despite conservative treatment, so the patient underwent an exploratory laparotomy, which revealed a prominent cecal bascule. Postoperatively, the patient improved following cecal bascule reduction and ileocolic anastomosis, and remained clinically stable with a functional ileostomy. While CDI is commonly associated with colonic complications such as toxic megacolon and bowel obstruction, its potential role in cecal bascule remains less well understood. Cecal bascule can present uniquely with ominous symptoms, as is seen increasingly in patients with recent colonic disease. Clinicians should keep cecal bascules in their differential diagnoses when patients present with intermittent abdominal pain, as early recognition of cecal bascules is essential for timely intervention before colonic ischemia and further irreversible tissue damage occur.

Keywords: bascule; cecal bascule; cecal volvulus; clostridioides difficile; large bowel obstruction.

Figure 1. Computed tomography scan of the abdomen and pelvis

Computed tomography scan of the abdomen and pelvis, completed on 2/6/2024, includes coronal (A) and axial (B) views. A colonic diverticulum is noted, as shown by the red arrow in (A); the duodenal diverticulum is not pictured in these specific slices of the scan.

Figure 2. Computed tomography scan of the abdomen and pelvis

Computed tomography scan of the abdomen and pelvis, completed on 2/11/2024, includes coronal (A) and axial (B) views. Gaseous distension of the cecum is seen in (A) and (B), as depicted by a red circle.