A Case of Ileus due to Mesenterium Commune, Course for Chronic and Recurrent, with Cancer of the Ileum

Masaya Tamura, Humihiko Kimoto, Katsumi Kiyosaki and Rinichirou Wakasa^*

Department of Surgery, Gastrointestinal Tract Division^*, Himi Clivil Hospital

A 66-year-old male who had developed intestinal obstruction repeatedly was admitted to our hospital because of abdominal fullness and constipation. Gastrointestinal X-ray examination and angiography revealed intestinal malrotation similar to a mesenterium commune. Abdominal computed tomography and barium enema examination suggested a tumor of the small intestine. An emergency operation was performed 18 days after admission, and revealed a partially dilated small intestine attached to the splenic flexure and twisted in a 360°clockwise rotation. An intestinal tumor was found at the center of the twisted intestine. The ascending colon and cecum were not fixed to the recessus retroperitoneum, and there was mesocolon ascendens. The intestinal tumor was located about 50cm on the oral side from the terminal ileum. Cancer of the ileum was doubtful, so a right hemicolectomy with regional lymph nodes dissection (D2) was performed. The resected material revealed that the tumor was 5×4cm in size, type 2, and well differentiated adenocarcinoma of se, ly₁, v₀, n (+). This case had the possibility to reveal unusual course, because the mesenterium commune could have led to a mistaken diagnosis of an associated lesion.

Key words
mesenterium, commune, intestinal obstruction, cancer of the ileum

Reprint requests
Masaya Tamura The First Department of Surgery, Kanazawa University School of Medicine

Accepted
September 22, 1999

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