[The mobile cecum syndrome: appendectomy and cecopexy or only appendectomy?]

1159 patients underwent appendectomy via a McBurney incision from 1972 to 1983 at our institution. 115 patients (10%) had a mobile cecum syndrome (CMS) as defined by Nicole, without evidence of appendicitis or other pathologic findings at operation. 102 patients were followed up to 15 years after the operation. 82% of the 102 patients were free of symptoms at assessment. 36 patients underwent appendectomy and 63 appendectomy and cecopexy. The two cohorts were comparable with respect to sex, age at operation, duration of right lower abdominal pain, operative findings and length of follow-up. There was no significant difference in the postoperative result of patients with appendectomy alone and those with appendectomy and cecopexy. Moreover, we were not able to identify patients who may benefit from an additional cecopexy, on the basis of patient related factors or intraoperative findings.

Coexistence of pancreas divisum and intestinal malrotation in a patient with cholecystolithiasis--a case report

An unusual case of a coexistence of pancreas divisum and intestinal malrotation in a patient with cholecystolithiasis is described herein. The diagnosis of pancreas divisum was established by endoscopic retrograde pancreatography, and the intestinal malrotation was diagnosed by duodenography and barium enema. An operation was performed for the cholecystolithiasis. The pancreas was soft, and its shape was almost normal. Cholecystectomy and prophylactic appendectomy were performed, however nothing was done to the pancreas.

Cystic duplication of the cecum lined by dermal type squamous epithelium

This is a case report of a cystic duplication of the cecum in a 6-month-old female infant, which was lined by both columnar and squamous epithelium. This squamous epithelium did not resemble esophageal epithelium but dermal epithelium. The so-called split notochord theory can explain the possibility of the coexistence of ectoderm and entoderm components. However, the present case had no vertebral abnormalities.

Familial small bowel atresia and stenosis

A family is described in which three individuals (two siblings and a second cousin) have presented with duodenal or jejunal atresia and duodenal stenosis in association with malrotation. The possible mode of inheritance is discussed.

A hypothesis on the allantoic origin of the distal midgut

No satisfactory explanation for the absence of the ileocecal portion of the digestive system in the newborns with cloacal exstrophy has been offered previously. This is a report of such a case in which the lymphocytes and plasma cells were used as tissue markers to identify the origin of the lymphatic-rich ileocecal portion of the digestive tract. The absence of these cells, in this case demonstrated immunohistochemically, is suggestive of a dual origin of the midgut. Normal embryogenesis of the digestive system is reviewed and the possibility of participation of the allantois, in addition to the yolk sac, in the embryogenesis of the ileocecal segment of the gastrointestinal tract is discussed.

Intussusception and intestinal malrotation in infants: Waugh's syndrome

The position of the duodenojejunal flexure was determined in 37 out of a group of 49 consecutive infants presenting with intussusception. The flexure was in a normal position in 19, at the midline in 3, and in an abnormal position in 15. The caecum was unfixed in all of the 41 infants subjected to operation. It is concluded that lack of normal rotation and fixation of the intestine is an important factor in the aetiology of idiopathic intussusception of infants.

Hirschsprung's disease and asymptomatic malrotation: a rare association

Intestinal malrotation and Hirschsprung's disease may be associated with other congenital anomalies. However, the association of Hirschsprung's disease with intestinal malrotation has been recently pointed out and sporadic cases are reported in the literature. We describe a case of such an association in a baby with asymptomatic malrotation and emphasize the diagnostic implications.

Ileocaecal atresia

Meconium ileus is one of the commonest causes of distal small bowel obstruction in neonates. Within the last six years at our hospital two newborns presented with identical signs and symptoms of meconium ileus. Abdominal x-rays showed distal small bowel obstruction with ground glass opacity in the right lower quadrant. Gastrografin enema in both cases demonstrated a microcolon, but there was no reflux of this contrast material into the terminal ileum. Laparotomy in both babies revealed atresia of the ileocaecal valve with dilatation of the terminal ileum loops which contained normal meconium. Ileocolic resection was carried out in both neonates. Sweat chlorides and eventual recovery were normal. Pathology in one of the specimens showed muscularis passing across the atretic area with a telescoped pattern of the muscularis propria suggesting intussusception in utero. Although the presentation of a newborn may be that of meconium ileus, the fact that the Gastrografin enema is unable to enter the terminal ileum in a retrograde fashion should be an indication for immediate laparotomy rather than persisting in this mode of treatment. It is obvious that occasionally the radiological diagnosis of meconium ileus is incorrect.

Pediatric surgical intraoperative consultations

Six problems that have surgical implications and that may be encountered unexpectedly during urologic procedures in infants and children are discussed. Evolving practice and increased knowledge about these conditions require that the consultant's opinion regarding their management be updated. Discussed are the indications for concomitant appendectomy in young patients and the pros and cons regarding removal of a Meckel's diverticulum encountered unexpectedly. The necessity for and techniques used to preserve the spleen in the face of operative injury, presence of a splenic cyst, or a wandering spleen are discussed. Finally, the implications of finding a rotational abnormality of the gut are reviewed.

Duplication of the caecum in a neonate simulating intussusception

A case of caecal duplication in a 36-h-old neonate is described. The patient presented with vomiting and an abdominal mass and the barium enema finding was initially suggestive of intussusception. At laparotomy a duplication cyst completely obstructing the lumen was found. This was considered to have given the radiological picture simulating intussusception.

Intestinal malrotation beyond the neonatal period

Of 162 children with intestinal malrotation treated during a 13-year period, only 20 were first seen and treated outside the neonatal period. These presented with symptoms that were largely non-specific and there was a delay between the initial consultation and the making of the correct diagnosis of up to 5-years. The clinical features, radiologic findings and management are discussed, the importance of the history and radiographic findings stressed.

Vermiform appendix located within the cecal wall. Anomalies and bizarre locations

The unusual finding of an acute appendix located within the posterior wall of the cecum, beneath the serosa, and its surgical removal is described. In order to remove the appendix, the cecal wall had to be incised. The appendix had no serosal covering, and had the gross appearance of a peeled seedless grape. The anatomy and embryology of the vermiform appendix, including this aberration, are presented briefly. A discussion of the difficult-to-find appendix is presented. The possibility exists that some of the reported cases of agenesis of the appendix could have been an overlooked intracecal appendix.

The cecal diaphragm

A detailed radiologic, colonoscopic, and histologic analysis is described in the case of a cecal web presenting as a "cecal mass." The demonstration of a transverse band-like lucency proximal to the ileocecal valve should prompt careful double-contrast barium studies, to which endoscopy may be added, enabling a correct diagnosis to be made.

[Ceco-ureterocele]

A case of caeco-ureterocele is presented, which is a rare special form of ectopic ureterocele and which was first described by Stephens. Its differential diagnostic characteristics compared with the prolapse of ureterocele are described. The article also discusses possible embryological causes which might explain this peculiar type of malformation.

A further case of hyperrotation of the colon

The anomalies resulting from abnormal rotation of the midgut loop are briefly reviewed. A case of hyperrotation with cecal ascent is described--only the second such case reported, so far as the authors are aware. The liver in this subject was larger than average, and the suggestion is made that the presence of a large liver combined with exuberant growth of the ascending colon may explain the hyperrotation. Although this anomaly is clearly very rare and not in itself pathological, the highly unusual position of the cecum and much of the ascending colon in these cases may cause problems in the diagnosis of appendicitis or during laparatomy.

[The mobile-cecum--a contribution to the independence of this disease and to its surgical treatment]

A mobile caecum can certainly exist perpetually without symptoms. The operation is indicated after a barium enema and upper gastro-intestinal x-ray examination if the symptoms-especially colicky abdominal pain-have been lasting for a long period. Caecum and ascending colon are fixed at the lateral abdominal wall as a "coecocolofixatio lateralis" (Klose 1909). 93.7% of our 35 patients had no postoperative complaints. The operation is not indicated as prophylaxis for volvulus or invagination.