Transverse Colon Volvulus Secondary to the Persistent Descending Mesocolon: A Case Report

TL;DR

This case report describes a rare instance of transverse colon volvulus caused by a congenital condition called persistent descending mesocolon in an 18-year-old woman.

Contribution

The paper highlights the under-recognized role of persistent descending mesocolon in causing recurrent transverse colon volvulus and surgical complications.

Findings

An 18-year-old female with a history of coarctation of the aorta and anal atresia experienced recurrent transverse colon volvulus due to persistent descending mesocolon.

Laparoscopic surgery revealed a medially positioned descending colon, and the patient faced postoperative anastomotic failure requiring a second operation.

The case emphasizes the importance of identifying persistent descending mesocolon to prevent complications like recurrent volvulus and surgical failure.

Abstract

This case report introduces a rare occurrence of transverse colon volvulus associated with persistent descending mesocolon (PDM), a congenital anomaly characterized by the medial positioning of the descending colon due to a failed fusion with the dorsal abdominal wall. We detail the case of an 18-year-old female, with a medical history of surgically corrected coarctation of the aorta and anal atresia, who presented with recurrent transverse colon volvulus despite having undergone a laparoscopic colopexy three years earlier. Physical examination revealed abdominal distension and metallic colic sounds while imaging studies confirmed the recurrence of the volvulus. Laparoscopic partial resection of the transverse colon was performed, which revealed a medially positioned descending colon due to PDM. Postoperative complications included anastomotic failure, necessitating a second operation. The patient was successfully discharged without further complications after seven days. This case underscores the clinical significance of recognizing PDM, highlighting its potential role in causing transverse colon volvulus and increasing the risk of anastomotic failure. It emphasizes the need for surgeons to remain vigilant regarding this congenital anomaly to mitigate unexpected outcomes such as recurrent volvulus and postoperative complications.

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