Imagerie du volvulus du grêle sur mésentère commun incomplet chez un adulte: rapport de cas

Abstract

Le diagnostic du volvulus du grêle peut se faire en urgence devant un tableau d´occlusion intestinale aiguë, voire un état de choc ou devant des douleurs abdominales répétées associées souvent à des troubles du transit. C´est une complication redoutable du mésentère commun incomplet, qui est définie comme une anomalie de rotation du tube digestif très rare à l´âge adulte. Sa symptomatologie clinique est non spécifique, d´où l´intérêt de connaitre ses caractéristiques radiologiques surtout scannographiques, permettant ainsi une prise en charge thérapeutique précoce. Nous rapportons l´observation d´un patient de 65 ans admis pour volvulus total du grêle sur mésentère commun incomplet diagnostiqué par tomodensitométrie (TDM) abdominale et confirmé par l´exploration chirurgicale, et chez qui l´évolution était favorable.

Incomplete Situs Inversus Revealed by Acute Pain of the Right Hypochondrium

“…The PSA may show hydro-aerosic levels of the small bowel in relation to a small bowel obstruction. It may not show any specific signs of volvulus on incomplete common mesentery [10].…”

“…The diagnosis of small bowel volvulus can be made in an emergency in the presence of an acute intestinal obstruction, or even a state of shock, or in the presence of repeated abdominal pain often associated with transit disorders. This is a dreaded complication of the common mesentery, which is defined as a rotation anomaly of the digestive tract and is very rare in adults [10]. CT is the gold standard for the diagnosis of this condition and its complications.However, the performance of the radiological examination must not delay the therapeutic management.…”

“…In addition to CT and ultrasound, the most accessible imaging modality in our context is the unprepared abdominal X-ray (UXR). It is requested as a first-line examination for occlusive syndrome, which is often present in small bowel volvulus [10]. The PSA may show hydro-aerosic levels of the small bowel in relation to a small bowel obstruction.…”

Incomplete common mesentery with Ladd's band and Meckel's diverticulum: A rare cause of small bowel obstruction

“…Intestinal malrotation is a disease of the newborn as it frequently manifests in the first month of life; adult manifestation is very rare [4] . Acute intestinal obstruction and enteromesenteric infarction are the main life-threatening complications of incomplete common mesentery [5] , [6] . Small bowel obstruction is frequently secondary to Ladd bands or volvulus [7] .…”

“…Adult patients rarely present with acute midgut volvulus or internal hernias caused by Ladd's bands. Often a diagnosis of intestinal malrotation is made incidentally on routine imaging [4] , hence the importance of knowing the radiological features, particularly scenographic features of this rare entity, thus enabling early therapeutic management [5] . On cross-sectional imaging, one should see the affected segment of the bowel twisted about the mesentery.…”