Cecal perforation in a pediatric patient caused by cecal bascule

Cecal volvulus is a rare condition. Cecal bascule, a variant of cecal volvulus, is also rare, with only a few cases reported in the literature. To the best of our knowledge, only one case of cecal bascule in a pediatric patient with neurological impairment has been reported. The clinical presentation of cecal bascule is similar to that of cecal volvulus. The goal of management in patients with cecal bascule is to prevent complications such as gangrene and perforation, which result in a high mortality rate. Here, we report the case of a 10-year-old boy who presented with intermittent pain, vomiting, and abdominal distension for 2 days. Abdominal radiography revealed a large dilated bowel loop with the air–fluid level occupying more than half of the total width of the abdominal cavity; however, features suggestive of small bowel obstruction were not observed. The patient was initially conservatively managed because of the partial relief of symptoms. However, following conservative management, signs and symptoms reappeared with greater intensity, suggestive of peritonitis. 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. The cecum was untwisted; it was markedly dilated and hypertrophied, and mobile, as shown by its nonfixation to the retroperitoneum. Perforation was observed at the base of the cecum. The cecum and ascending colon were resected, and an ileotransverse anastomosis was performed. Thereafter, the condition of the patient improved and remained favorable. Differential diagnosis of cecal volvulus and cecal bascule should be considered in patients presenting with pain, vomiting, and abdominal distension, and whose abdominal X-rays reveal a large dilated bowel loop with an air–fluid level. We suggest resecting the hypermobile cecum in pediatric patients with cecal bascule.