EccoMamba: Enhanced Cross-hierarchical Continuity Orthogonal Mamba for Medical Image Segmentation

Medical image segmentation plays a crucial role in clinical diagnosis, lesion quantification, and preoperative planning. However, existing Mamba-based architectures, which rely on fixed-direction sequence modeling and flatten images into one-dimensional (1D) sequences, struggle to capture hierarchical anatomical features and spatial dependencies, thereby limiting their representational capacity for complex medical structures. To address these limitations, we propose EccoMamba (Enhanced Cross-hierarchical Continuity Orthogonal Mamba), a U-shaped encoder--decoder framework designed for medical image segmentation. In the encoder's downsampling path, we introduce a Hierarchical Aggregation Enhancement (HAE) module that integrates multi-scale convolutions with hierarchical attention mechanisms. The attention branch further incorporates cross-channel interactions, allowing the model to selectively enhance semantically relevant features while suppressing irrelevant background responses. For skip connections, we design a Structural Continuity Orthogonal (SCO) module to preserve spatial continuity by modeling cross-dimensional dependencies via orthogonal Axial Shifts (AS), thereby mitigating directional bias and improving anatomical consistency. Extensive experiments on four benchmark datasets---ISIC 2018, ISIC 2017, Synapse, and ACDC---show that EccoMamba consistently outperforms state-of-the-art methods in both segmentation accuracy and structural fidelity.