Descending colon volvulus in a patient with persistent left mesocolon: A case report

Abstract

Persistent descending mesocolon is a congenital anomaly in which the mesentery of the descending colon fails to fuse with the retroperitoneum, resulting in a mobile colon that is suspended by a mesentery extending from the left upper quadrant to the pelvic brim. This can predispose to intestinal obstruction by twisting of the colon, internal hernia with or without a mesenteric defect or intussusception. We present a case report of a 30-year-old male who presented with recurrent abdominal pain and distension, with a CT diagnosis of descending colonic volvulus due to persistent left mesocolon. The patient underwent a successful resection of the affected colon and had an uneventful recovery. This case highlights the importance of considering anatomical variants in the diagnosis and management of colonic volvulus.

Keywords: CT scan diagnosis; Colonic resection; Descending colonic volvulus; Diagnostic imaging; Intestinal obstruction; Persistent descending mesocolon.

Fig. 1

CT topogram: significantly distended colonic loop occupying the left upper abdomen.

Fig. 2

Contrast-enhanced CT scan: A-B axial images; C-D-E reconstructed images in coronal plane: CT scans revealed the presence of a redundant descending colon, characterized by an excessive loop displaced in the left supramesocolic space. This segment was overdistended, measuring up to 11 cm in diameter. Coronal reconstruction provided a detailed view, highlighting the swirling appearance of the afferent vascular structures. The ascending colon appeared within normal size parameters, whereas the distal descending colon and sigmoid colon exhibited collapsed walls.

Fig. 3

Surgical specimen: dilated segment of the descending colon extending approximately 25 cm, characterized by thinned walls and a lumen diameter of up to 10 cm.