Caecal bascule: a case series and literature review.
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.


CONCLUSIONS
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.
Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Jin-Soo
JS
Park
Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.
Kheng-Seong
KS
Ng
Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia.
Christopher J
CJ
Young
D000368:Aged; D001315:Australia; D002429:Cecal Diseases / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D045822:Intestinal Volvulus / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
caecal bascule; caecal diseases; caecal volvulus; intestinal obstruction; intestinal volvulus