br Introduction Cecal volvulus is a rare

Introduction Cecal volvulus is a rare condition in the pediatric population. Cecal bascule, a variant of cecal volvulus, is a condition in which the cecum anteriorly folds over the ascending colon, leading to large bowel obstruction. Cecal bascule is also rare, with only a few cases reported in the pediatric population. Cecal bascule was first described by Dijkstra in 1899. Its detailed clinical and radiological characteristics were reported by Weinstein in 1938. The clinical presentation and treatment of cecal bascule are similar to those of cecal volvulus, but the radiological findings of the conditions differ. Although cecal bascule is typically observed in the elderly population, we report the case of a 10-year-old boy with cecal bascule. Abdominal radiography revealed cecal volvulus; however, the condition was overlooked because of its rarity. This case report will increase awareness among clinicians of the clinical features of this unusual cecal volvulus variant and of preventing its complications such as gangrene and perforation.
Case Report Laboratory examination revealed a fty720 level of 10.1 g/dL and a total leukocyte count of 12,600 cells/mm. Liver function tests revealed a total bilirubin level of 1.2 mg/dL, a marginally increased level of serum transaminase, and an alkaline phosphatase level of 349 IU/L (high). Renal function and serum electrolyte levels were normal. Abdominal ultrasonography was inconclusive. Radiographic features suggestive of small bowel obstruction were absent but there was a large dilated bowel loop with the air–fluid level occupying more than half of the total width of the abdominal cavity (Figure 1); however, this finding was overlooked. Computed tomography (CT) was unavailable. The patient was initially conservatively managed because of the partial relief of symptoms (absence of pain and passage of feces) within 24 hours of admission. However, following conservative management, signs and symptoms gradually reappeared with greater intensity, suggestive of peritonitis. Radiography revealed free gas under the domes of the diaphragm (Figure 1). This precipitated a laparotomy, which revealed that the peritoneal cavity was filled with flakes and fluid, and that the cecum was anteromedially folded in front of the ascending colon (Figure 2). The cecum was untwisted; it was markedly dilated and hypertrophied, and mobile, as demonstrated by its nonfixation to the retroperitoneum (Figure 3). In addition, the ascending colon was elongated, and perforation was observed at the base of the cecum (Figure 3). The cecum and ascending colon were resected, and an ileotransverse anastomosis was performed; an abdominal drain was placed in the pelvic cavity. The patient was administered third-generation cephalosporin postoperatively. On the seventh postoperative day, 15 mL feculent discharge from the drain was noted when enteral feeding was started. The general condition of the patient was stable and abdominal signs suggestive of peritonitis were absent, thus, a conservative approach was followed for the fecal fistula to heal spontaneously. The feculent output remained within 10–40 mL for 1 week. In addition, oral intake (soft diet) was encouraged. Despite the feculent output, the drain was removed at the end of the third postoperative week because the patient was stable, had adequate oral intake, and passed normally formed stools. His abdominal drainage tract was believed to have matured adequately for preventing contamination of the peritoneal cavity. The spontaneous closure of the fistula was observed 1 week after drain removal. Thereafter, the patient maintained a favorable condition and received regular follow-up.
Discussion Colonic volvulus, a common condition in adults aged over 60 years, was first described by Rokitansky in 1837. Compared with sigmoid volvulus, cecal volvulus occurs less frequently. Cecal volvulus is a rare condition, with an incidence ranging from 2.8 to 7.1 per million people per year. Cecal volvulus is even rarer in children.