Laparoscopic Management of Mobile Cecum.
OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
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.
Department of Surgery.
Carlos Augusto
CA
Gomes
Department of Surgery.
Cleber
C
Soares
Department of General Surgery, Maggiore Hospital, Parma, Italy.
Fausto
F
Catena
Department of Surgery, Maggiore Hospital, Bologna, Italy.
Salomone
S
Di Saverio
Department of Surgery, Macerata Hospital, Macerata, Italy.
Massimo
M
Sartelli
Department of Surgery, Israel Pinheiro Governor Hospital, Belo Horizonte, Minas Gerais, Bazil.
Camila Couto
CC
Gomes
Department of Internal Medicine, Therezinha de Jesus University Hospital, Faculty of Medical and Health Sciences of Juiz de Fora (SUPREMA), Minas Gerais, Brazil.
Felipe Couto
FC
Gomes
D000328:Adult; D002429:Cecal Diseases / Q000175:diagnosis / Q000601:surgery*; D002432:Cecum / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
Cecal volvulus; Laparoscopic cecopexy; Mobile cecum