Caecal Bascule Causing Bowel Obstruction: A Case Report on a Rare and Important General Surgical Pathology

Author(s): Arad Khodarahmi, Rahdakrishnan Nair

Introduction: Caecal bascule, a rare variant of caecal volvulus, accounts for <2% of large bowel obstructions and 5-20% of caecal volvuli. Unlike classic volvulus, it lacks axial twisting and results from an antero-medial folding of the caecum, leading to obstruction. Presentation typically includes nausea, vomiting, abdominal pain, distension, and constipation. Prompt diagnosis is critical to prevent ischaemia or perforation. This report presents an 85-year-old female with a small bowel obstruction secondary to caecal bascule.

Case Presentation: An 85-year-old female presented with a 2-day history of worsening right-lower-quadrant pain, nausea, and mild appetite loss, but no vomiting or fever. Examination revealed abdominal tenderness and mild distension without rigidity. Imaging identified distal ileal obstruction and a flipped, dilated caecum consistent with caecal bascule. Conservative management failed, prompting surgical intervention. A laparoscopy converted to laparotomy revealed a caecal bascule with ischaemic mucosa. Right hemicolectomy with ileocolic anastomosis was performed. Postoperative ileus required parenteral nutrition, but recovery was prompt and the patient was discharged by day 10. Histopathology showed obstruction and ischaemia with incidental appendiceal mucinous adenoma without malignancy. Follow-up revealed no complications.

Discussion: Caecal bascule, first described in 1899, arises from embryologic mal-fixation of the caecal mesentery. Diagnosis relies on clinical assessment and CT imaging. While non-operative management has low success, resection or colopexy prevents recurrence. Early surgical intervention improves outcomes, as mortality can reach 14% with delayed treatment.

Conclusion: This case emphasizes the importance of timely diagnosis and surgical management for caecal bascule, a rare but significant cause of bowel obstruction.