Ascending colon volvulus with a transmesocolic hernia in a young adult: a case report
Susana Henriques, Diogo G. Cruz, Nuno Carvalho, Carlos LuzIntroduction:
Volvulus of the cecum and ascending colon represents a rare but critical etiology of acute intestinal obstruction. It likely results from a congenital failure of fusion of the colon to the parietal peritoneum during embryogenesis and may be associated with other anatomical anomalies, such as congenital mesocolic defects.
Presentation of case:
An 18-year-old man presented with a 4-day history of progressive abdominal pain localizing to the right iliac fossa, associated with nausea and vomiting. Despite inconclusive but abnormal findings on computed tomography, persistent signs of an acute abdomen led to surgical exploration. Intraoperative findings revealed a volvulus of the cecum and ascending colon caused by congenital malrotation with absent lateral peritoneal attachments of the large bowel, along with internal herniation of small-bowel loops through a large congenital defect in the mesocolon. The volvulus was detorsed, the herniated small-bowel loops were reduced, and the defect was closed primarily.
Conclusion:
This case highlights the diagnostic difficulty of congenital anomalies in adults, as symptoms are often nonspecific and insidious. Given the rarity of such presentations in adulthood, a high index of clinical suspicion is essential.