Simultaneous caecal volvulus through a congenital mesenteric defect and proximal intussusception

Excerpt

A 55-year-old man presented with acute vomiting and abdominal distension. He had three prior hospital admissions over the previous year for similar symptoms, which resolved spontaneously within a short time. Plain abdominal X-rays showed a grossly dilated caecum occupying the left upper quadrant consistent with a caecal volvulus. This was confirmed on CT scan, which also showed a dilated stomach and proximal duodenum and a collapsed mid-small bowel. An unsuccessful attempt was made to deflate the patient by colonoscopy. The patient was taken to the operating room that night where laparotomy revealed a grossly distended caecum due to caecal volvulus (Fig. 1) that was initially deflated by needle caecostomy. Dissection of the right colon showed the caecum herniating through a congenital mesenteric defect located in the terminal ileal mesentery (Fig. 2). The defect was enlarged with a performance of standard stapled right hemicolectomy. Proximal assessment of the small bowel also showed a mid-jejunal intussusception with no obvious leading point (Fig. 3) which was reduced. There was no associated intra-abdominal lymphadenopathy. The patient underwent small bowel resection and anastomosis. Histology confirmed colonic ischaemia with mesenteric fibrosis near the mesenteric defect. The small bowel only showed mucosal oedema without any distinct pathology. The patient made an uneventful recovery and was asymptomatic at 12-month follow-up.

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