More Than Appendicitis: Laparoscopic Diagnosis and Graded Management of Mobile Caecum Syndrome- A Case Article

Background: Mobile caecum syndrome is a rare congenital anomaly caused by incomplete retroperitoneal fixation of the caecum and ascending colon. It often presents with recurrent or chronic right iliac fossa (RIF) pain, clinically resembling acute appendicitis. Preoperative diagnosis is challenging, with intraoperative detection being the primary method of identification. Objective: This observational study assessed intraoperative diagnosis, grading, and outcomes of laparoscopic caecopexy in mobile caecum syndrome, while identifying associated laparoscopic markers. Methods: Thirty patients aged 18–40 years with RIF pain and ultrasonographic suspicion of appendicitis underwent diagnostic laparoscopy. Intraoperatively, mobile caecum was identified and graded using Gomes’ classification. Associated findings, such as thickening of the ileocecal (IC) junction and distal ileum, were recorded. Laparoscopic caecopexy was performed in all cases. Symptom resolution was assessed using Visual Analog Scale (VAS) scores preoperatively and at 1, 3, and 6 months postoperatively. Data were analyzed using ANOVA (p < 0.005). Results: Mobile caecum was confirmed in all patients (60% Grade I, 40% Grade II). IC junction and distal ileal thickening were noted in 53.3%, particularly in all Grade II cases. A suprapubic camera port allowed improved visualization, aiding diagnosis. Histopathology showed a normal appendix in 30% of cases. VAS scores significantly declined over time (F = 65.23, p = 1.13 × 10⁻⁹⁹). No major complications occurred; eight patients had transient postoperative ileus. Conclusion: Laparoscopic caecopexy is a safe, effective treatment for mobile caecum syndrome. Improved visualization and identification of IC thickening may support diagnosis. Routine intraoperative assessment is recommended.