Ileocecal volvulus in an infant with dorsal mesenteric agenesis: A case report

Intestinal volvulus due to agenesis of the dorsal mesentery is an exceptionally rare cause of intestinal obstruction in infants, with few cases reported in the literature. A 3-month-old female presented with a 2-day history of abdominal pain, persistent vomiting, progressive abdominal distension, and constipation. She appeared ill and dehydrated, with marked tachycardia and fever. Examination revealed a distended, tender abdomen with absent bowel sounds and an empty rectum. Laboratory tests showed anemia and leukocytosis. Abdominal radiograph demonstrated dilated small bowel loops with multiple air–fluid levels and no distal gas. After resuscitation with intravenous fluids, insertion of a nasogastric tube and urethral catheter, initiation of broad-spectrum antibiotics, and transfusion of packed red blood cells, she underwent urgent exploratory laparotomy. Intraoperatively, the entire small intestine lacked its mesentery and was supplied solely by a single large marginal artery. An ileocecal volvulus with a freely mobile cecum was identified. Detorsion was performed, the bowel was viable, and the mesenteric defect was closed by approximating the peritoneal edges along the marginal vessel. Recovery was uneventful, with oral feeding resumed on postoperative day five and discharge on day seven. At six-month follow-up, the child demonstrated normal growth, feeding tolerance, and no recurrent symptoms. Dorsal mesenteric agenesis with volvulus must be considered in the differential diagnosis of infants who develop acute intestinal obstruction.