Congenital mesenteric absence of mid-gut with ileal volvulus: a case report

Transmesenteric hernia caused by mesenteric defects are rare causes of intestinal obstruction in children. Here, we report a rare mesenteric defect, which was completely mesenteric in absence, with the defect extending from the mesenteric root to the ascending colon.

A 4-year-old Han Chinese boy presented to the surgical emergency department with a 1-day history of abdominal pain and vomiting. An X-ray examination of the abdomen revealed intestinal obstruction. The patient was diagnosed with intestinal obstruction and was advised to undergo laparoscopy. Laparoscopy revealed a large mesenteric defect, with the defect extending from the mesenteric root to the ascending colon, and a single mesenteric vessel supplied the small intestine. The single mesenteric vessel passed along the small intestine and crossed with the distal ileum, which trapped the distal ileum, leading to intestinal obstruction. During surgery, the distal ileum was transected and reanastomosed in front of the mesenteric vessel to relieve the intestinal obstruction, and the mesenteric defect was closed to prevent mesenteric hiatal hernia. There was no recurrence of intestinal obstruction during the follow-up.

A complete mesenteric defect with ileal volvulus is a rare cause of intestinal obstruction. Prompt exploration based on clinical signs is mandatory to establish the diagnosis and provide immediate therapy. This can reduce morbidity and mortality in this rare life-threatening disease.