Navigating the Labyrinth: When the "Mesenterium Commune" Turns Colonoscopy into an Endoscopic Rollercoaster

Area of Science:

• Gastroenterology
• Medical Imaging
• Embryology

Background:

• A 51-year-old woman presented with recurrent chronic abdominal pain, iron deficiency, and diarrhea, previously diagnosed with celiac disease.
• Despite a gluten-free diet, her symptoms persisted, prompting further investigation.

Purpose of the Study:

• To investigate the cause of persistent gastrointestinal symptoms and diagnostic challenges in a patient with suspected malrotation.
• To identify the rare anatomical variant responsible for the patient's chronic abdominal pain and diagnostic difficulties.

Main Methods:

• Abdominal ultrasound and colonoscopy were performed, but the colonoscopy was incomplete due to anatomical challenges.
• Virtual colonoscopy was utilized to visualize the entire colon and identify the underlying anatomical abnormality.

Main Results:

• Virtual colonoscopy revealed an extremely rare condition known as Mesenterium commune (MC), a form of congenital gut malrotation.
• The entire colon was found to be malpositioned on the left side of the abdomen, curled within the small pelvis.

Conclusions:

• Mesenterium commune is a rare congenital anomaly that can cause significant gastrointestinal symptoms and diagnostic challenges.
• Early recognition and diagnosis of MC are crucial for preventing complications such as intestinal obstruction and acute abdomen.