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To hypothesize that mobile cecum is a rare etiological factor and cecopexy is the choice of treatment in patients with recurrent right lower abdominal pain. Prospective study was conducted in the department of general surgery, SSG Hospital, Baroda, from January 2008 to December 2009. Patients with recurrent right lower abdominal pain were planned for appendectomy. In those patients with intraoperative findings suggestive of macroscopically normal appendix while cecum found to be mobile and no other gross abnormality, appendectomy was performed with cecopexy, fixing cecum to lateral abdominal wall with polypropylene 3-0 suture in interrupted manner. Histopathological examination was confirmed in all the cases. A total of 110 patients complaining of recurrent right lower abdominal pain, with clinical and radiological findings suggestive of appendicitis, were planned for appendectomy. Of 110 patients, 20 were found to have macroscopically normal appearing appendix and of those 20 patients, 8 had cecum unattached to the lateral peritoneal wall. The rest of 90 patients had grossly inflamed appendix in which 10 patients had cecum unattached to the lateral peritoneal wall. Appendectomy and cecopexy were performed in all the patients. On histological examination of the excised appendices, of those 20 with macroscopically normal appearance, 11 had features suggestive of chronic appendicitis and remaining 9 patients were found to have normal histology. While the other 90 with grossly inflamed appendix showed pathological changes of acute inflammation. A total of 64 patients of 110 were followed up till date with no recurrence of abdominal pain. A mobile cecum should be considered a cause of recurrent right lower abdominal pain, and cecopexy is easy to perform and good treatment of choice for a mobile cecum.
To hypothesize that mobile cecum is a rare etiological factor and cecopexy is the choice of treatment in patients with recurrent right lower abdominal pain. Prospective study was conducted in the department of general surgery, SSG Hospital, Baroda, from January 2008 to December 2009. Patients with recurrent right lower abdominal pain were planned for appendectomy. In those patients with intraoperative findings suggestive of macroscopically normal appendix while cecum found to be mobile and no other gross abnormality, appendectomy was performed with cecopexy, fixing cecum to lateral abdominal wall with polypropylene 3-0 suture in interrupted manner. Histopathological examination was confirmed in all the cases. A total of 110 patients complaining of recurrent right lower abdominal pain, with clinical and radiological findings suggestive of appendicitis, were planned for appendectomy. Of 110 patients, 20 were found to have macroscopically normal appearing appendix and of those 20 patients, 8 had cecum unattached to the lateral peritoneal wall. The rest of 90 patients had grossly inflamed appendix in which 10 patients had cecum unattached to the lateral peritoneal wall. Appendectomy and cecopexy were performed in all the patients. On histological examination of the excised appendices, of those 20 with macroscopically normal appearance, 11 had features suggestive of chronic appendicitis and remaining 9 patients were found to have normal histology. While the other 90 with grossly inflamed appendix showed pathological changes of acute inflammation. A total of 64 patients of 110 were followed up till date with no recurrence of abdominal pain. A mobile cecum should be considered a cause of recurrent right lower abdominal pain, and cecopexy is easy to perform and good treatment of choice for a mobile cecum.
RESUMO: O ceco móvel é uma variação anatômica embriológica do ceco e cólon ascendente resultante da descida incompleta desses segmentos do intestino grosso e da não fixação no peritônio da goteira parieto-cólica direita. A falta dessa fusão permite movimentação do ceco e/ou do cólon ascendente, facilitando a torção sobre seu eixo longitudinal ou a dobra medial do ceco sobre si, ficando encostado com sua borda medial à borda medial do cólon ascendente. Esse fato causa sintomas intermitentes de obstrução parcial do intestino ou, no caso de torção completa (volvo), de obstrução aguda com possível necrose do segmento envolvido. A anormalidade embriológica tem alta incidência (10 a 30% na população), contudo só tem sido mencionada por ocasião da torção completa, inadequadamente denominada de volvo do ceco-ascendente, em geral com necrose cecal. Dessa forma, a ocorrência não é das mais comuns e está citada entre as causas de obstrução intestinal aguda, perfazendo, nos adultos e nas crianças, menos do que 2% de todos os casos de obstruções intestinais, mas com a importância de destaque por causa do alto índice de morbi-mortalidade entre os pacientes afetados. O objetivo foi apresentar o ceco móvel como causa de dor abdominal intermitente, distensão, empachamento e cólica de origens obscuras em pessoas de aparência saudável, mas com uma longa história de distúrbios gastrintestinais funcionais, associados à constipação e/ou diarréia, portanto, com um quadro sintomatológico sobreponível ao da síndrome do cólon irritável. Além disso, propomos um marcador anatômico para a síndrome do cólon irritável, seja o subtipo com constipação predominante, seja o da diarréia predominante ou a forma em que há alternância entre constipação e diarréia e a possibilidade de alívio daqueles sintomas com a cecopexia.Descritores: Desordens gastrintestinais funcionais, síndrome do ceco móvel, síndrome do cólon irritável, adultos, crianças, constipação intestinal, diarréia, distensão abdominal, dor abdominal, cecopexia. Thompson 1 , num editorial no "Gastroenterology" (2006), introduziu o seguinte comentário: "O diagnós-tico médico tradicional de uma moléstia exige observações de anomalias anatômicas e fisiológicas", formando um conjunto que se expressa por sinais e sintomas, de tal modo que "o médico pode, com bases nesses dados clínicos, prognosticar a respeito das alterações anatomopatológicas do órgão envolvido" e exercitar a medicina baseada em evidências.Isso não é o que ocorre quando estamos diante das doenças gastrintestinais funcionais. Essas doenças são caracterizadas pela ausência de alterações anatômicas ou morfológicas demonstráveis e de qualquer dado laboratorialmente mensurável que possam representá-las ou definí-las. Assim, o diagnóstico é elaborado pelo que expressam os pacientes na tentativa de descrever um quadro sintomatológico subjetivo de sensações "interoceptivas" transmitidas por vias neurovegetativas a núcleos centrais subcorticais.O subjetivismo e a falta de demonstração prá-tica de um substrato anatomopatológico ou de ...
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