Cecal bascule herniation into the lesser sac

Abstract

Cecal bascule is a rare cause of bowel obstruction in which a mobile cecum folds anteriorly and superiorly over the ascending colon. Herein, we present the first case of internal herniation of a cecal bascule into the lesser sac through the foramen of winslow, aiming at discussing radiological findings, differential diagnosis, and surgical management of this uncommon condition. A 75-year-old female presented to the emergency room with an 18-h history of sudden onset sharp, progressively worsening abdominal pain associated with vomiting. Physical exam revealed abdominal distention and epigastric tenderness while initial laboratory tests were unremarkable. Computed tomography of her abdomen and pelvis showed a loop of distended colon within lesser sac without signs of bowel ischemia or perforation. On exploratory laparotomy, a cecal bascule was found herniating into lesser sac via foramen of winslow. Upon reduction, the cecum appeared viable therefore a cecopexy was performed without bowel resection. Unlike cecal volvulus, cecal bascule consists of no axial rotation of the bowel with no mesenteric vascular compromise and therefore ischemia would only occur from intraluminal tension or extraluminal compression from the borders of foramen of winslow. The management of internal herniation of a cecal bascule is always surgical including anatomic resection or cecopexy.

Keywords: Cecal, Bascule, Hernia, Internal, Foramen, Winslow

Core tip: Cecal bascule is a rare and overlooked cause of large bowel obstruction in which a mobile cecum folds anteriorly and superiorly leading to obstruction of ascending colon. Although cecal bascule has been described in association with mechanical bowel obstruction in the literature, its association with this type of internal hernia has never been described before. The management of internal herniation of a cecal bascule is always surgical even in the absence of peritonitis, either cecopexy or right hemicolectomy depending on the viability of the bowel segment involved.