Acute total intestinal volvulus caused by sclerosing mesenteritis: a case report and review of the literature.

BACKGROUND

Intestinal volvulus arises from the twisting of an intestinal loop around a fixed axis. This condition is distinguished by both the obstruction and constriction of the intestinal lumen, as well as the entrapment of intestinal blood vessels. Consequently, the intestinal obstruction resulting from volvulus is often of the strangulating variety, which poses a risk for swift intestinal necrosis. Mesenteric tumors are a notable precipitant of volvulus. However, certain nontumor lesions originating from the mesentery can also lead to severe intestinal volvulus.

CASE PRESENTATION

A 68-year-old Chinese female individual was hospitalized because of severe abdominal pain that occurred 6 h after engaging in physical labor. An abdominal computed tomography examination revealed volvulus of the mesenteric root and the presence of a mixed-density mass in the right mesentery, with the possibility of a neoplastic process not ruled out. Emergency surgical exploration confirmed that the small mesenteric tumor served as a pivot, with the mesenteric root twisted 1440°, leading to total necrosis of the small intestine. As a result, total small intestine resection and enterostomy were performed. Postoperative pathological examination of the mesenteric tumor revealed fat necrosis, excessive calcification, peripheral fibrous tissue hyperplasia, and chronic inflammatory cell infiltration, consistent with a diagnosis of sclerosing mesenteritis. The patient's life was saved through timely surgical intervention. However, owing to the development of short bowel syndrome, she will require long-term dependence on parenteral nutrition.

CONCLUSION

Intestinal volvulus due to sclerosing mesenteric inflammation is an exceedingly rare occurrence. Clinicians should maintain a high index of suspicion for this condition when encountering cases of intestinal volvulus attributed to mesenteric tumors. Prompt and decisive surgical intervention is crucial for saving lives and for preserving as much of the intestinal tract as possible.