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Received Oct 31, 2017; Revised Jan 8, 2018; Accepted Jan 11, 2018
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1. Introduction
Mobile cecum is anatomically defined as an anomalous position of the right colon, cecum, and terminal ileum due to the failure of the right colon mesentery to fuse with the posterior parietal peritoneum. Embryogenesis of bowel is a complex process that begins during the 5th gestational week and involves three phases: herniation, return to the abdomen, and fixation [1, 2]. Anomalies of rotation and fixation of the gastrointestinal tract are frequently associated with other embryological defects, but per se the suspension on a mesentery of the cecum and ascending colon may allow them to freely rotate and cause a wide spectrum of symptoms included in the “mobile cecum syndrome.” This condition can be asymptomatic, as it has been found in 11.2% of autopsies [3, 4]. On the other hand, it can also clinically manifest as a chronic syndrome including constipation, abdominal distension, and recurrent abdominal pain or, more rarely, as an acute bowel obstruction due to cecal volvulus (1–1.5% of all adult intestinal obstruction) [5]. This study reports a series of five patients presenting for a symptomatic mobile cecum that required surgical treatment (mostly by laparoscopy).
2. Methods
In the last ten years, five patients were admitted at the Surgery Unit of San Martino Hospital (Genoa, Italy), since they presented different symptoms due to an anomalous position of the cecum. Two patients came after a history of recurrent lower quadrant pain and abdominal distension (chronic form of the disease); the other three patients arrived with an acute form of cecal volvulus (acute form for the disease). Patients gave written informed consent prior to entering the study. The protocol adheres to the principles of the Declaration of Helsinki. 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].
Table 1