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Mobile Cecum Syndrome

The cecum is a section of the intestinal tract. It lies at the junction of the small and the large intestines and is the origin of the appendix. Mobile cecum syndrome describes abdominal pain accompanied by a cecum that is not properly attached to the rest of the abdomen. According to Schwartz's "Principles of Surgery," it is not clear precisely what degree of detachment is sufficiently abnormal to be considered the probable cause of symptoms. Detachment of the cecum can be responsible for an uncommon yet serious condition called volvulus of the cecum, which is distinct from mobile cecum syndrome.

  1. Abdominal Anatomy

    • Internal structures in the abdomen can either be inside or outside the peritoneum, a membrane of connective tissue that forms a cavity in one part of the abdomen. Peritoneal structures, such as the liver, stomach and sigmoid colon, lie inside the peritoneal capsule, suspended to it by connective tissue called mesentery. Retroperitoneal structures, such as the duodenum, cecum and ascending colon, lie behind the peritoneum attached to the back wall. According to Schwartz's "Principles of Surgery," it is common for retroperitoneal structures such as the cecum to be only partially attached to the back wall through normal variations in development.

    Detecting a Detached Cecum

    • It is not possible to accurately determine the extent that the cecum is attached through radiological imaging, so most reports of a detached cecum have arisen from autopsy or surgery for another abdominal condition, most often appendicitis. According to a 2007 article published in "Diseases of the Colon & Rectum," in some cases of abdominal pain of unknown origin surgeons have operated and found the cecum more detached than they judged to be normal. The surgeons sutured the cecum to the peritoneum, and most patients subsequently reported improvements in pain levels. These experiences led to coining of the term mobile cecum syndrome.

    Problems Measuring Detachment

    • Because there is no reliable nonsurgical method for measuring attachment of the cecum, it has not been possible to compare what degree of detachment is typical for patients with and without unexplained abdominal pain. Surgeons have considered the detachment to be abnormal if the patient has symptoms, which is of course a circular definition. The improvement of symptoms after reattaching the cecum does not necessarily demonstrate that detachment was the cause, since it has been well established that there is a placebo effect associated with undergoing a surgical procedure.

    Problems with Unexplained Abdominal Pain

    • Unexplained abdominal pain, often accompanied with diarrhea or constipation, is quite common. Irritable bowel syndrome is a common condition in which patients experience pain that cannot be explained. Some patients with irritable bowel syndrome may have a detached cecum simply by coincidence, without mobile cecum syndrome necessarily being the cause.

    Volvulus

    • Volvulus is a condition in which one part of the intestines twists around upon itself, potentially cutting off blood supply. Volvulus of the cecum is uncommon, with the sigmoid colon being a much more typical site. Cecum volvulus is usually accompanied with a high degree of detachment and may not be possible without it. But volvulus should not be confused with mobile cecum syndrome, where there is no compromise of blood supply to account for the pain.

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