Sunday, April 10, 2011
Portal Venous Gas and Cecal Bascule
Most cases of cecal volvulus involve the twisting of a redundant, poorly fixated cecum around its ileocolic pedicle. Cecal bascule is a weird variant of cecal volvulus wherein its anterior wall folds over on itself oddly. I can't describe it in words very well. The first picture above may or may not be helpful.
Anyway, I operated on this lady recently who presented with portal venous gas and had peritoneal signs on exam. A deep fold in the anterior wall of the cecum delineated the extent of the gangrene present, isolated to the anterolateral aspect of the cecum. We did an ileocolectomy and she ended up doing well. Then I went home and looked up the word "bascule", because it sounded so stupid. Sure enough, I found it is a French word meaning "seesaw" or "balance". Drawbridges operate on a similar principle. My daughter loves seesaws. There's a park around the corner from where we live that has one. She makes me ride it with her for longer than I would normally enjoy.