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Program

WSU Medical School

Training Level

Medical Student

Institution

Wayne State University

Abstract

Cecal bascule, initially described in 1899 by Treves, is the rarest form of cecal volvulus and represents a phenomenon when a redundant and distended cecum folds anteriorly over the ascending colon causing an intestinal obstruction. Patients with cerebral palsy are at increased risk for this condition. We present a 28-year-old male with cerebral palsy, fully functionally dependent in activities of daily living, who presented to the emergency department with a large loop ileostomy prolapse which was the result of an inverted prolapsed cecum due to a cecal bascule. What differentiated this patient from others is that the prolapsed portion was the efferent limb of the ileostomy with the intussuscepted cecum and the entire right colon. To correct this, he underwent a right hemicolectomy with end ileostomy and transverse mucous fistula creation through the previous ostomy site. He progressed well appropriately postoperatively and was discharged home.This report highlights the rare phenomenon of cecal bascule, a form of cecal volvulus, as a cause of large bowel obstruction. Patients with cerebral palsy represent an important demographic for this condition due to presence of risk factors including chronic constipation, immobility and neurogenic bowel dysfunction. Patients with cecal bascule are amenable to a number of treatment options depending on the presence or absence of bowel compromise as well as the hemodynamic stability of the patient. These range between cecopexy with or without cecostomy to ileocecectomy or right hemicolectomy with or without proximal diversion. A high index of suspicion is warranted in all cases of large bowel obstruction to minimize risk of recurrence, morbidity and mortality for patients afflicted by this condition.

Publication Date

5-2019

Colonic Prolapse of Efferent Stoma in Patients with Cecal Bascule

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