Cecal volvulus is one of

Cecal volvulus is one of the manifestations of intestinal malrotation and fixation abnormality. During embryogenesis, the mesentery of the right colon fuses with the lateral wall, resulting in cecal fixation. Cecal volvulus occurs in patients with a mobile cecum (nonfixation of the cecum and right colon to the retroperitoneum). Defective peritoneal fixation resulting in the abnormal mobility of the ascending colon and cecum occurs in 10% to 20% of the population. In addition, this mtor inhibitor fixation abnormality is the main cause of left-sided Amyand\'s hernia and De Garengeot hernia. Volvulus occurs in the ascending colon above the ileocecal valve and results in one of two variants. Axial torsion, the more frequent or classical type, is a twist along the longitudinal axis of the ascending colon (involving the cecum, terminal ileum, and ascending colon), resulting in vascular compromise along with obstruction. The second type or variant is the cecal bascule (< 10% cases). Bascule is a French term that means a seesaw or counter-balanced bridge. In a cecal bascule, as observed in our case, the cecum folds anteriorly and cephalad to the ascending colon in the transverse plane, enabling the anterior surface to fold back on itself. This produces a flap-valve occlusion at the site of flexion, with ileal contents passing unidirectionally into the cecum (in the presence of a competent ileocecal valve), thereby resulting in massive cecal distension. This is a type of closed-loop ascending colon obstruction. Adhesions form between the ascending colon and anterior cecal wall, and the cecal pole can be directed either uppermost (as observed in our case) or medially. In a large Japanese case series, the first episode of cecal volvulus was reported to occur between 10 years and 29 years of age, followed by another episode between 60 years and 79 years of age. The occurrence of cecal volvulus and cecal bascule has been reported in elderly people who underwent abdominal surgery, both following the dissection of peritoneal attachments and after cesarean section. It has been proposed that adhesions create a point of fixation, enabling the development of cecal bascule. Precipitating factors for cecal volvulus in children include sudden colonic distention, trauma, chronic constipation (as observed in our case), distal colonic obstruction, colonic ileus, colonoscopy, traction because of a diseased appendix, postoperative abdomen, and procedures related to medial visceral rotation. In addition, cecal volvulus, but not cecal bascule, has been reported as a complication after the antegrade colonic enema procedure. An increased incidence of cecal volvulus has been reported in children with neurological impairment, particularly after fundoplication. Cecal bascule was reported in a pediatric patient with trisomy 13 who developed this condition after laparoscopic Nissen fundoplication. The development of this condition was believed to be due to the increased intestinal air resulting from considerable airophagy and antireflux operation. In our case, the patient did not have any relevant medical history. The clinical presentation of cecal volvulus is diverse and is characterized by intermittent episodes of colicky pain to sudden onset, excruciating abdominal pain, vomiting, obstipation, borborygmus, and fluid and electrolyte disturbance. The clinical presentation of cecal bascule is similar to that of cecal volvulus. Intermittent subacute obstruction is caused by the flopping of the cecum back into its anatomical location. Cecal bascule may be associated with signs of incomplete obstruction; the small bowel is not obstructed, and the distended, air-filled cecum is located more centrally or in the right hypochondrium (as observed in our case). A delay in diagnosis increases distention and the severity of complications like cecal perforation, as observed in our case. In the classical type of cecal volvulus, strangulation occurs as a result of venous and arterial compromise, which may lead to gangrene and colonic perforation, and thus a high mortality rate. In cecal bascule, cecal perforation occurs as a direct consequence of massive cecal dilatation, whereas strangulation is unlikely because the mesentery is not frequently twisted.