Complete common mesentery revealed by a cecal bascule: Two case reports.

Area of Science:

• Surgical Gastroenterology
• Embryonic Development
• Abdominal Imaging

Background:

• Complete common mesentery (CCM) arises from midgut malrotation during embryonic development.
• Cecal volvulus (CV), particularly the bascule subtype, is a rare complication of CCM causing acute intestinal obstruction.
• The bascule subtype involves the cecum folding anteriorly over the ascending colon.

Observation:

• Two cases of acute intestinal obstruction due to Cecal Bascule (CB) secondary to CCM are presented.
• One patient was misdiagnosed with a strangulated umbilical hernia and operated on without prior imaging.
• Both patients underwent open right colectomy with primary intestinal anastomosis and recovered well.

Findings:

• CCM involves disrupted embryonic intestinal rotation, leading to abnormal fixation and a mobile right colon.
• Cecal bascule represents a rare presentation (<10% of CV) of CCM.
• Diagnosis can be challenging on CT scans due to altered anatomy, requiring vigilance from radiologists and surgeons.

Implications:

• Early recognition of CCM and its complications like CB is crucial for timely surgical management.
• Right hemicolectomy with ileocolic anastomosis is the standard surgical treatment for CB in CCM.
• Awareness among surgeons and radiologists is vital, as misdiagnosis can lead to delayed treatment of this rare condition.