Is Loop Ileostomy in Patients with Cecal Bascule a Viable Option?

Abstract

Background. 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. Case Presentation. We present a 28-year-old male with cerebral palsy, functionally dependent in all activities of daily living, who had undergone a loop ileostomy for cecal bascule. He then presented to our emergency department with a large loop ileostomy prolapse, which was the result of an inverted prolapsed cecum through the efferent ileostomy limb. 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. Conclusions. While cecal bascule is a rare form of bowel obstruction, patients with cerebral palsy are at an increased risk for this condition. The treatment options are numerous and are primarily surgical. Diverting loop ileostomy alone is not a recommended treatment. 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.

Cecal Bascule in a COVID-19 Positive Patient: Case Report

“…In addition to resection, cecopexy should be performed to fix the remnant right colon to the posterior abdominal wall and reduce the risk of future volvuli. 16 In our case, a right hemicolectomy with primary ileocolic anastomosis was performed since the patient was hemodynamically stable and not on any inotropes at the time of surgery. Also, there was no bowel compromise or any fecal spillage at laparotomy, hence, we believe that this was the right treatment option for the patient at that time.…”

“…After resection, reconstruction as primary anastomosis or ileostomy with a mucous fistula depends on the physical status of the patient prior to surgery as well as intraoperative findings. 16 Patients who are hemodynamically stable with no bowel compromise should undergo a right hemicolectomy with primary ileocolic anastomosis. 16 In patient with hemodynamic instability and compromised bowel the surgeon should opt for an ileostomy following bowel resection.…”

“… 16 Patients who are hemodynamically stable with no bowel compromise should undergo a right hemicolectomy with primary ileocolic anastomosis. 16 In patient with hemodynamic instability and compromised bowel the surgeon should opt for an ileostomy following bowel resection. 16 The ileostomy could be reversed at a later operation.…”

“… 16 In patient with hemodynamic instability and compromised bowel the surgeon should opt for an ileostomy following bowel resection. 16 The ileostomy could be reversed at a later operation. In addition to resection, cecopexy should be performed to fix the remnant right colon to the posterior abdominal wall and reduce the risk of future volvuli.…”