About one case of common mesentery: embryological study, morphological profile and interest of the doppler ultrasound

Abstract

Common mesentery is an anatomical abnormality resulting from a defect in the embryonic development of the digestive tract, resulting in a fetal disposition of the intestine in patients. It is mostly revealed during the neonatal period and in children with severe accidents of occlusion. At the anatomo-embryological level, the common mesentery is the consequence of malrotation and attachment of the primary intestinal loop during its embryological development. Attachment abnormalities may or may not be associated with rotation abnormalities (the latter favor them), and they are of 2 types: excessive attachments or attachments defects.We report the case of an 8-years-old female patient received in the emergency room for severe abdominal pain, inability to pass stools and gas, and bilious and incoercible vomiting for 2 days. The surgical exploration showed a volvulus of the small bowel with a 270° clockwise rotation, and the presence of a complete common mesentery and numerous mesenteric lymphadenopathies. The stomach and colon were distended, with adhesions between the colon and the small bowel, but no ischemia or intestinal perforation was noted. The operative procedures consisted of untwisting the volvulated loops in an anti-clockwise direction(270°), a release of adhesions, an appendectomy. We also emptied the small intestine and repositioned it.Common mesentery is a rare pathological state and its incidence is poorly understood due to clinical latency. But a good knowledge of embryology, attentive listening to patients and an accurate reading of the various radiological examinations can lead us thinking about malrotation. The occurrence of occlusive accidents is the main frequent cause of discovery of this abnormality.