CT Diagnosis of Volvulus of the Descending Colon with Persistent  Mesocolon

Chen, Albert; Yang, Fei-Shih; Shih, Shou-Chuan; Sheu, Chin-Yin

doi:10.2214/ajr.180.4.1801003

Cited by 21 publications

(13 citation statements)

References 6 publications

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“…Although pathology was negative for neoplasm, they theorized the lack of zygosis with persistent ascending and descending mesocolons helped to enable this presentation [3]. Furthermore, persistent descending mesocolons have been noted in previous reports as the etiology of colonic volvulus [8,9] and internal hernia [10]. …”

Section: Discussionmentioning

confidence: 99%

Total ileocolic intussusception with rectal prolapse presenting in an adult: a case report and review of the literature

2013

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IntroductionIntussusception is rarely encountered in adults, accounting for just 5% of all occurrences and 1% of bowel obstructions. In up to 90% of episodes of adult intussusceptions, operative intervention is required secondary to pathological lead points. Prior to the current report, only three cases of total ileocolic intussusception with rectal prolapse in adults have been described in the world literature, making it an important contribution to surgical knowledge. In addition to a discussion of disease etiology, this review outlines sound diagnostic and therapeutic principles in the successful management of this rare emergent surgical condition.Case presentation and literature reviewIn this case report, we will present a rare case of total ileocolic intussusception with rectal prolapse in a 22 year-old female without antecedent history. She had both a lead point in the cecum, as well as a highly mobile, intraperitoneal colon. Lead points have been found in only half of the reported cases, including this one. In addition, colonic laxity may enable this phenomenon, being attributed to the loss of zygosis during the embryological period, in which there is persistence of the ascending and descending mesocolons and lack of apposition to the retroperitoneum. The diagnostic work-up, operative strategy and pathological findings are discussed. The three previous cases reported in the English-language medical literature were reviewed.ConclusionsAdult intussusception, while uncommon, may be encountered in an acute surgical setting and optimal outcomes depend on a high index of suspicion and expeditious management. Embryological divergence may contribute to the even rarer variant of total ileocolic intussusception with rectal prolapse.

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Section: Discussionmentioning

confidence: 99%

Total ileocolic intussusception with rectal prolapse presenting in an adult: a case report and review of the literature

2013

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“…Persistent mesocolon is a developmental anomaly characterized by the colonic mesentery's failure to fuse with the dorsal abdominal wall (1). Although some clinical complications of persistent mesocolon, such as primary intestinal obstruction, colonic volvulus, and intussusception (2)(3)(4), have been reported, this condition is asymptomatic in most cases (1). In patients with persistent ascending and descending mesocolons, the sigmoid colon is located under the ascending colon.…”

Section: Introductionmentioning

confidence: 99%

“…In patients with persistent ascending and descending mesocolons, the sigmoid colon is located under the ascending colon. Although some clinical complications of persistent mesocolon, such as primary intestinal obstruction, colonic volvulus, and intussusception , have been reported, this condition is asymptomatic in most cases . Such failure of fixation has often been demonstrated radiographically , and some cases of persistent mesocolon were recently reported in the field of laparoscopic colon cancer surgery .…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons: A case report

Hisano

Ueki

Kono

et al. 2018

Asian J Endoscop Surgery

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Persistent mesocolon is an embryological anomaly of the colon resulting from failure of the primitive dorsal mesocolon to fuse with the parietal peritoneum. We herein present a case of laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons and a right-bound inferior mesenteric artery. Preoperative 3-D CT demonstrated that the sigmoid colon had shifted to the right abdomen and was located under the ascending colon. Moreover, the inferior mesenteric artery and vein traveled toward the right abdomen accompanied by the mesentery of the descending colon. Adhesiolysis between the ascending and sigmoid colon was initially performed, and the sigmoid colon was placed in its normal position. The inferior mesenteric artery was then divided with lymph node dissection using a medial approach, and high anterior resection was completed. An understanding of the anatomical characteristics of persistent mesocolon is important to ensure safe laparoscopic surgery.

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“…Failure of completion of this leaves a persistent right mesocolon in about 25 per cent of the population, and a left one in about 33 per cent [8]. Clinical complications that have been associated with these anatomical variations include: primary intestinal obstruction [9], and colonic volvulus as a result of a persistent descending mesocolon [10]. Persistence of the mesocolon of both, ascending and descending parts of the colon, has manifested as colonic varices [11].…”

Section: Introductionmentioning

confidence: 99%

Anal protrusion of an ileo-colic intussusception in an adult with persistent ascending and descending mesocolons: a case report

Ongom¹,

Lukande²,

Jombwe³

2013

BMC Res Notes

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BackgroundIntussusception is one of the less common causes of intestinal obstruction among adults. It is usually covert (concealed) in its clinical presentation. The ileo-colic type with accompanying anal protrusion is extremely rare. The case at hand is that of both an ileo-colic intussusception with anal protrusion, in the presence of a persistence of both the ascending and descending mesocolons; a case possibly yet to be documented in literature.Case presentationA 32 year-old African-Ugandan woman presented with complaints of a mass protruding per anus for 2 weeks. It was reducible and associated with colicky abdominal pain, loose stools, and bloody-mucoid discharge per anus. She had previously had a one and a half month’s history of abdominal pain; periodically continuous, while other times colicky in character. Examination and investigations revealed an intussusception with a partial intestinal obstruction. At laparotomy she was found to have an ileo-colic intussusception with a freely mobile colon throughout its length. There were persistent ascending and descending mesocolons, and absent hepatocolic and splenocolic ligaments. The intussusceptum was ‘milked’ but not completely reducible. A right hemicolectomy was done, with ileo-transverse colonic anastomosis. Histopathological examination revealed no preexisting pathologic lesion as a lead point.ConclusionThe persistence of the ascending and descending mesocolons (azygosis) best explains the anal protrusion of an ileo-colic intussusception with partial obstruction. In this case zygosis (normal retroperitoneal ascending and descending colonic positioning) failed embryologically. This experience is particularly beneficial to general surgeons, radiologists, gastroenterologists, colorectal surgeons and pathologists.

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CT Diagnosis of Volvulus of the Descending Colon with Persistent Mesocolon

Cited by 21 publications

References 6 publications

Total ileocolic intussusception with rectal prolapse presenting in an adult: a case report and review of the literature

Total ileocolic intussusception with rectal prolapse presenting in an adult: a case report and review of the literature

Laparoscopic high anterior resection for triple colorectal cancers with persistent ascending and descending mesocolons: A case report

Anal protrusion of an ileo-colic intussusception in an adult with persistent ascending and descending mesocolons: a case report

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