Adult Midgut Volvulus Secondary to Mesenterium Commune and Enteric Duplication Cyst: A Case Report

Abstract

We report a case of adult superior mesenteric volvulus secondary to malrotation of the intestine and jejunal enteric duplication cyst. A 20-year-old man seen for abdominal pain was found in enhanced computed tomography (CT) to have a cystic lesion adjacent to the inferior surface of the liver and a whirl sign of the superior mesenteric artery and vein, so we diagnosed the case as strangulation ileus due to volvulus of the superior mesentery, conducting emergency laparotomy. We found that the ascending colon was not anchored to the retroperitoneum, and the intestine from the jejunum to the transverse colon showed ischemic change with volvulus of 720 degrees rotation clockwise. Reduction of volvulus improved ischemia. We also found a 7cm cyst in the mesenterium of the jejunum approximately 20cm from Treitz.s ligament, necessitating partial resection of the jejunum including the cyst. We conducted appendectomy but did not fix the ascending colon to the retroperitoneum. Macroscopic findings showed a solitary cystic tumor on the jejunal mesentery adjoining the alimentary tract but without communication. Microscopic findings indicated a smooth muscle layer in the cyst wall lined internally with epithelium analogous to the respiratory tract. We diagnosed this as enteric duplication cyst.