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

Abstract

The mobile cecum syndrome includes a spectrum of conditions. The cecal volvulus represents the acute form, with typical feature of a bowel obstruction that needs immediate operative treatment. On the other hand, a chronic form of mobile cecum syndrome which is the most common form reported a history of intermittent crampy abdominal pain, distension, and constipation. In this study, five patients came to our attention during the last ten years, presenting different symptoms due to a mobile cecum. All patients were investigated by several diagnostic techniques according to the specific clinical setting. All patients were found to have the cecum and ascending colon unattached to the posterior peritoneum. Surgery was the treatment of choice. In our experience, the best diagnostic technique was computed tomography scan, especially if performed in the Trendelenburg position. We also propose virtual colonoscopy as a good option for diagnosis (in patients with chronic syndrome) and follow-up after surgery. In conclusion, laparoscopic approach guaranteed a good result, with no symptoms of recurrence, in both acute and elective treatments. The diagnosis of mobile cecum needs a high index of suspicion and a targeted radiological investigation. Surgery, especially laparoscopic cecopexy and appendectomy, is the recommended treatment.

Caecal Volvulus

“…This may be associated with caecal bascule and occurs due to increased mobility of the caecum. It is characterised by recurrent, intermittent abdominal pain and distension which typically resolves on passage of flatus [18,28]. Vomiting may occur in only 30% of the patients [18].…”

“…Due to the quick resolution of symptoms, diagnosis of the mobile cecum syndrome can be difficult. Cesaretti et al [28] advise performing computed tomography in Trendelenburg position and propose use of virtual colonoscopy to aid diagnosis of mobile caecum syndrome.…”

“…A laparoscopic approach is currently considered safe in both the acute and elective setting [28,37]. In a series of 15 patients with mobile caecum syndrome who underwent laparoscopic caecopexy, Gomes et al [29] report a very favourable outcome with 84% achieving a modified Visick score [44] of 1 while up to 92% had only a Grade I Clavien-Dindo classification [45].…”

Two sisters with a rare cause of infantile colic

“…The operative steps include insufflation using carbon dioxide to create pneumoperitoneum, followed by incising the peritoneum lateral to the unattached portion of the colon and then stitching of the cecum and the ascending colon under a flap of parietal peritoneum, with the free edge of the flap sutured to the tenia coli by interrupted absorbable sutures. Thus, the colon is partially fixed to the retroperitoneum …”

Internal hernia with incarceration of the cecum through a loop created by an elongated fallopian tube

“…It results from the failure of the right colonic mesentery to fuse with the lateral peritoneum during embryogenesis. The condition is often asymptomatic; however, the mobility can lead to kinking or torsion of the cecum or ascending colon with associated stasis, obstruction, or volvulus [5] , [6] , [7] , [8] . The mobility may also provide the rare opportunity for the cecum and/or ascending colon to be involved in internal herniation [9] , [10] , [11] , [12] , [13] .…”