Case 8. Diagnosis

Cecal Ileus

Canadian Journal of Surgery 1996; 39: 120

See also: Case 8. Presentation
In 1938, a condition known as cecal bascule was described,[1] which involved folding of the right colon without twisting, so that the cecum occupied a position in the mid-abdomen. The term bascule is derived from bascula, the Latin word for scale. The point at which the ascending colon is folded represents the fulcrum of the scale. The entity also requires a loosely attached right colon, also seen in cecal volvulus.[2] In this particular case, cecal volvulus can be excluded because a considerable amount of gas is seen in the transverse colon. In cecal volvulus, usually little, if any, gas is seen distally in the colon.

The concept of cecal bascule has recently been challenged by those who believe that these patients have a focal adynamic ileus of the cecum.[3] Perforation may occur in up to 20% of patients with cecal dilatation. The duration of cecal distension is more important than cecal diameter in predicting impending perforation.

Whether cecal bascule represents an actual anatomic folding of the right colon or an adynamic ileus is not as important as the recognition of a dilated, ectopically located cecum as a source of the symptoms and potential perforation. Treatment with colonoscopy and decompression is usually successful. In this patient three attempts at decompression were unsuccessful, so percutaneous cecostomy was done. The follow-up film of the abdomen shows the decompressed colon after catheter placement.

References

  1. Weinstein M: Volvulus of the cecum and ascending colon. Ann Surg 1938; 107: 248-259
  2. Bobroff LM, Messinger NH, Subbarao K et al: The cecal bascule. AJR 1972; 115: 249-252
  3. Messmer JM: Gas and soft tissue abnormalities. In Gore RM, Levine MS, Laufer I (eds): Textbook of Gastrointestinal Radiology, v 1, WB Saunders, Philadelphia, 1994: 176-177
|  CJS: Apr. 1996 |  Surgery and orthopedics |
CMA webspinners