Volvulus total du grele sur mesentere commun incomplet, une complication exceptionnelle chez l’adulte: à propos d’un cas

Abstract

Le volvulus total du grêle complique le mésentère commun incomplet correspond à un arrêt de la rotation à 180° de l'anse intestinale primitive. La racine du mésentère est très courte et l'ensemble de l'intestin grêle se trouve pédiculé sur l'axe artériel mésentérique supérieur. Cette situation est à très haut risque de volvulus du grêle et d'infarctus entero-mésentérique. Le volvulus aigu impose une intervention chirurgicale en urgence; l'imagerie ne doit pas retarder la prise en charge chirurgicale. Le geste chirurgical consiste à la détorsion du volvulus (dans le sens antihoraire), la viabilité de l'intestin appréciée. L'intestin est rangé position de mésentère commun complet: cœcum dans la fosse iliaque gauche. Nous rapportons l'observation d'un patient de 60 ans admis pour volvulus total du grêle sur mésentère commun incomplet, opéré en urgence avec une évolution postopératoire favorable.

Incomplete common mesentery with Ladd's band and Meckel's diverticulum: A rare cause of small bowel obstruction

“…Intestinal malrotation or incomplete common mesentery is caused by the partial or complete failure of 270 degrees' counterclockwise rotation of the midgut around superior mesenteric vessels in fetal life [4] . Embryologically, it is malrotation and joining of the primitive intestine that is causing the incomplete common mesentery [1] , so the root of the mesentery is very short, and the whole small intestine is located on the superior mesenteric artery axis [2] , the peritoneal fibrous band – also known as Ladd's band –can compress duodenum causing a duodenal obstruction [4] . Intestinal malrotation is a disease of the newborn as it frequently manifests in the first month of life; adult manifestation is very rare [4] .…”

“…The common mesentery is an abnormal rotation of the primitive intestinal loop or omphalomesenteric loop during embryonic development, occurring very rarely in adults [1] . This defect is always congenital [2] . It is not necessarily symptomatic, but a clinical presentation of acute bowel obstruction on the band or volvulus can reveal it.…”

Value of CT in the Diagnosis of Mechanical Flange Occlusion of the Proximal Small Intestine Complicating an Incomplete Common Mesentery in an Adult: A Case Report

“…It is characterized by the persistence of an embryonic anatomical arrangement secondary to an anomaly of rotation of the primitive intestinal loop, thus constituting a meso common to the entire intestinal loop and to the root of the mesentery. This insufficient rotation is most often associated with a lack of fit [5].…”

“…The duodenojejunal angle is fixed to the right of the spine. Thus, the first jejunal loop and the last ileal loop are located close to the superior mesenteric axis and very close to each other [5]. There are tight flanges joining the cecum to the posterior abdominal wall called Ladd flanges [1].…”

Total small bowel volvulus on incomplete common mesentery, an exceptional complication in geriatric patients: A rare case report

“…The entire intestinal loop shares thus one common mesentery which has an extremely short root [ 1 , 2 ]. This rotation deficiency is most often associated with a defect of attachment [ 4 , 5 ]. Dreadful and even fatal complications of this intestinal malrotation usually occur during the neonatal period or at pediatric age [ 2 ].…”