What is the treatment for a mobile cecum?

Treatment of Mobile Cecum Syndrome

Cecopexy is the definitive treatment for mobile cecum syndrome, with laparoscopic approach being the preferred surgical technique due to its minimally invasive nature and excellent outcomes.

Clinical Presentation and Diagnosis

Mobile cecum syndrome occurs when the cecum and ascending colon are not properly attached to the posterior parietal wall, allowing abnormal mobility. Patients typically present with:

• Chronic, intermittent right lower quadrant cramping pain
• Abdominal distension
• Symptomatic relief after passing flatus or bowel movements
• Symptoms that may mimic functional bowel disorders

Diagnostic Approach:

1. CT scan - most effective diagnostic tool, especially when performed in Trendelenburg position 1
2. Barium enema - may demonstrate abnormal cecal mobility 2
3. Virtual colonoscopy - useful for diagnosis and post-surgical follow-up 1
4. Colonoscopy - helpful in acute presentations to rule out other pathologies and potentially reduce volvulus if present 3

Treatment Algorithm

1. Acute Presentation (Cecal Volvulus)

When mobile cecum presents as cecal volvulus with bowel obstruction:

• Emergency intervention required
• Initial attempt at colonoscopic reduction if patient is stable 3
• Surgical intervention with laparoscopic approach if possible
• Cecopexy with fixation to lateral peritoneum using interrupted sutures 3
• Consider appendectomy during the same procedure 1

2. Chronic Presentation

For patients with chronic intermittent symptoms:

• Elective laparoscopic cecopexy is the treatment of choice 4
• The cecum is secured to the lateral peritoneum using interrupted non-absorbable sutures
• A lateral peritoneal flap technique can be used for fixation 2
• Concurrent appendectomy is recommended to prevent future diagnostic confusion 1

Surgical Technique

The recommended surgical approach involves:

1. Laparoscopic exploration to confirm diagnosis
2. Grading of ileocecal-appendiceal unit displacement:
   • Grade I: Cecum retroperitoneal or with little mobility (no intervention needed)
   • Grade II: Wide mobility, crossing the midline (cecopexy indicated)
   • Grade III: Maximum mobility, reaching the left abdomen (cecopexy indicated) 4
3. Fixation of the cecum and ascending colon to the lateral peritoneum with interrupted sutures 3

Outcomes and Follow-up

• Laparoscopic cecopexy has shown excellent outcomes with high patient satisfaction 4, 1
• Most patients experience complete resolution of symptoms following surgery 5, 2
• Low complication rates have been reported with the laparoscopic approach 4
• Mean operative time is approximately 41 minutes 4

Important Considerations

• Mobile cecum syndrome is often misdiagnosed as functional bowel disease or chronic appendicitis 4
• Many patients undergo unnecessary appendectomy without symptom resolution 5
• A high index of clinical suspicion is needed for proper diagnosis 1
• Failure to properly fix the cecum can lead to recurrence or development of cecal volvulus
• When exploring for suspected internal hernia or obstruction, begin at the ileocecal junction and work proximally 6

Laparoscopic cecopexy is minimally invasive and provides cosmetic, physical, and economic benefits compared to open surgery, making it the preferred approach for treating mobile cecum syndrome 3.