Herniated mobile descending colon

Abstract

Persistent descending mesocolon is a congenital anomaly that has been shown, in most cases, to be asymptomatic because of its short length. To the best of our literature review and knowledge, no case of internal herniation of the mobile descending colon into either gastrocolic or splenocolic recesses have been reported. We therefore wish to report a case of herniated mobile descending colon in a middle-aged woman. HA was a 54-year-old female with a 2-year history of recurrent episodes of left upper quadrant pain of the abdomen. The pain, which was initially dull aching, suddenly became sharp in nature and so severe that it precluded her from doing her domestic activities. She had undergone clinical evaluation and work up previously but no etiology for her pain was found. After resuscitation, she consented to exploratory laparatomy for an acute on-chronic abdominal pain of unknown etiology. The intraoperative findings were a portion of the wall of the left colon seen to have herniated into a small band of tissue on the left posterior wall. The whole descending colon was unattached to the posterior peritoneum. The trapped portion (4 cm in length) of the wall of the colon was released and a warm pack was applied to the segment of large bowel so released. Following this maneuver, the portion was found to be viable and so a left colopexy was performed and the adhesion band that was placed obliquely from the spleen toward the midline was excised. Postoperative period was uneventful and since then the patient′s abdominal pain has been abated over the past 1 year. The morbidity of a mobile descending colon includes internal herniation. Therefore, early detection and colopexy is necessary.