Under normal physiological conditions, all surfaces of the cecum are covered by the peritoneum. However, in 5% of people, the posterior aspect of the upper cecum may lack peritoneal coverage and have an underdeveloped mesentery, resulting in a certain degree of mobility, though the range of movement should not exceed 6 cm. Nevertheless, if during embryonic development the mesentery of the right colon fails to fuse with the lateral peritoneum, the mobility of the cecum and ascending colon can significantly increase. Even if they remain in their normal anatomical position in the lower right abdomen, abnormal movement can lead to torsion, displacement, and sometimes even crossing the midline to the left side, causing a series of symptoms associated with partial intestinal obstruction. This condition is known as hyperkinetic cecum syndrome.

bubble_chart Etiology

It is caused by congenital factors. During embryonic development, the right mesocolon and the lateral abdominal membrane fail to fuse, resulting in abnormal hypermobility of the cecum and ascending colon.

bubble_chart Clinical Manifestations

Patients often experience cramping pain in the right lower abdomen, which may occur intermittently. Some may experience referred pain to the right lumbar region or even the upper abdomen, accompanied by diarrhea or constipation, or alternating between the two. In severe cases, clinical manifestations of pseudo-incomplete intestinal obstruction may occur. A small number of patients may experience worsening diarrhea after taking laxatives.

bubble_chart Auxiliary Examination

(1) Barium enema: Can show abnormal hypermotility or even displacement of the cecum.

bubble_chart Diagnosis

The patient's symptoms can be significantly relieved after defecation or passing gas, which is one of the important characteristics of this disease and thus serves as a highly valuable diagnostic clue. The definitive diagnosis of this condition mainly relies on barium enema imaging, and in some individual cases, the mobility of the cecum can only be detected during surgery.

bubble_chart Treatment Measures

In 1948, Dixon and Meyer first performed cecopexy using a lateral peritoneal flap. The method involved making an incision on the lateral abdominal wall to free the cecum, creating a pedicled free flap. Then, a gauze ball was used to further mobilize the cecum and ascending colon at the mesenteric attachment. The pedicled peritoneal flap was then placed over and fixed to the anterior wall of the cecum and ascending colon, positioning part of the cecum and ascending colon behind the peritoneum.