Laparoscopic Management of Mobile Cecum

Abstract

Background and Objectives:The mobile cecum is an embryologic abnormality and has been associated with functional colon disease (chronic constipation and irritable bowel syndrome). However, unlike functional disease, the primary treatment is operative, using laparoscopic cecopexy. We compare the epidemiology and pathophysiology of mobile cecum syndrome and functional colon disease and propose diagnostic and treatment guidelines.Method:This study was a case–control series of 15 patients who underwent laparoscopic cecopexy. Age, gender, recurrent abdominal pain, and constipation based on Rome III criteria were assessed. Ileocecal–appendiceal unit displacement was graded as follows: I (cecum retroperitoneal or with little mobility); II (wide mobility, crossing the midline); and III (maximum mobility, reaching the left abdomen). Patients with Grades II and III underwent laparoscopic cecopexy. The clinical outcomes were evaluated according to modified Visick's criteria, and postoperative complications were assessed according to the Clavien-Dindo classification.Results:The mean age was 31.86 ± 12.02 years, and 13 patients (86.7%) were women. Symptoms of constipation and abdominal pain were present in 14 (93.3%) and 11 (73.3%), respectively. Computed tomography was performed in 8 (53.3%) patients. The mean operative time was 41 ± 6.66 min. There were no postoperative infections. One (7.8%) patient was classified as Clavien Dindo IIIb and all patients were classified as Visick 1 or 2.Conclusion:Many patients with clinical and epidemiological features of functional colon disease in common in fact have an anatomic anomaly, for which the treatment of choice is laparoscopic cecopexy. New protocols should be developed to support this recommendation.

Acute intermittent porphyria after right hemi-colectomy

“…However, we believe that based on the imaging and operative findings the initial diagnosis of our patient was mobile cecum syndrome [15]. We initially performed laparoscopy which confirmed the diagnosis of mobile cecum syndrome.…”

Surgery to Treat Symptomatic Mobile Cecum Syndrome Is Safe and Associated with Good Recovery Outcomes

“…Literature reports only eight cases of mobile cecum syndrome or cecal volvulus treated by laparoscopic surgery [ 3 , 6 , 17 – 21 ]. In our experience, laparoscopic cecopexy using a peritoneal flap is a valid therapeutic approach that could be adopted in both chronic and acute manifestations of anomalous cecum position with excellent results and no recurrence of symptoms in a medium term follow-up.…”

“…The cases of acute and chronic forms of the diseases are summarized in Table 1 . The grade of lack of peritoneal attachment of the right colon was graded as follows: I (cecum retroperitoneal or with little mobility), II (wide mobility, crossing the midline), and III (maximum mobility, reaching the left abdomen) [ 6 ].…”

Volvulus of the ascending colon due to failure of zygosis: A case report and review of the literature

“…Prompt recognition may prevent disastrous consequences. Laparoscopic cecopexy is currently the preventative procedure of choice [4]. We report a case of an adult male who presented with volvulus of the entire right side of the colon and discuss the embryology as well as the clinical implications of this interesting entity.…”