Cecal bascule: a rare variant of cecal volvulus – case report

Introduction and importance: Cecal volvulus (CV) is an uncommon cause of large-bowel obstruction. Among its three variants, cecal bascule (CB) is the rarest, representing 5–20% of cases. Because of its atypical presentation and subtle radiologic features, diagnosis may be delayed, potentially leading to life-threatening complications. Presentation of case: We report the case of a 72-year-old woman admitted to the emergency department with clinical signs of intestinal obstruction. Abdominal computed tomography demonstrated a markedly dilated cecum displaced toward the midline and left upper quadrant, without the characteristic “whirl sign.” Exploratory laparotomy confirmed the diagnosis of CB. A right hemicolectomy with primary ileo-transverse anastomosis was performed. The postoperative course was complicated by a surgical site infection and pneumonia, both managed successfully with local wound care and antibiotic therapy. Clinical discussion: This observation illustrates the diagnostic challenges of CB, an often underrecognized entity. Prompt surgical intervention is critical to avoid severe complications such as ischemia or perforation. Resection with primary anastomosis appears to be a safe and effective emergency option, providing definitive treatment and minimizing recurrence risk. Conclusion: Although traditionally considered rare, reports of CB have increased in recent years. Our case is notable for its occurrence in the absence of classical predisposing factors, highlighting the need for a high index of suspicion in patients presenting with acute colonic obstruction. Awareness of this entity and early surgical management are essential to optimize patient outcomes.