Congenital mesenteric defect causing volvulus and intestinal obstruction in an adult

A 39-year-old female presented with a history of recurrent pain abdomen for 2 years. The pain was colicky and intermittent in nature. She had been diagnosed to have right-sided nephrolithiasis based on the findings of computed tomography (CT) abdomen and was managed conservatively during each episode of pain. During the present episode, her pain started 4 days prior to presentation and was associated with vomiting and inability to pass stool and flatus. X-ray abdomen showed evidence of dilated bowel loops. On clinical examination, her abdomen was distended with tenderness and guarding in the right lower abdomen. Her CT abdomen revealed dilated ileal loops in the right lower abdomen. The distal bowel was found to be collapsed. On exploratory laparotomy, a volvulus of the distal ileum, caecum and part of ascending colon was noted. The involved bowel loops were gangrenous. A mesenteric defect of about 10 cm was noted in the root of the mesentery, which had caused an internal herniation, volvulus and gangrene. She underwent a right hemicolectomy with covering ileostomy. Congenital mesenteric defects leading to internal herniation are a well-documented condition in pediatric population. Although the same can occur in adults, it is an infrequent cause of intestinal obstruction.