Presentation
The patient presented with history of long time constipation and left leg swelling with DVT detected on doppler ultrasound, to assess the extension of the DVT.
Patient Data
Oblique course of descending colon with small bowels seen lateral to it, features are consistent with persistent descending mesocolon.
The sigmoid colon is seen in the right iliac fossa with evidence of irregular wall thickening with speculation, as well as evidence of invasion of the anteriorly located small bowels and the postero-superiorly located proximal transverse colon. Features are suggestive of malignant lesion rather than old complicated diverticulitis, colonoscopy was recommended.
Thrombosis of the visualized left common and superficial femoral veins, representing DVT. No evidence of thrombosis in the iliac veins and IVC.
Incidental finding of filling defects in the visualized segmental branches of bilateral lower pulmonary arteries, representing pulmonary embolism.
Exophytic lesion arising from the subcutaneous tissue of left lateral aspect of the abdomen is noted, measuring about 55 x 16 mm, it has heterogeneous fatty component, suggestive of dermatofibrosarcoma protuberans.
Case Discussion
The persistent descending mesocolon is a rare anatomical variant. It presents as medialization of the descending colon with small bowels seen lateral to it. It is usually asymptomatic, however, it has a clinical significance as it has complications such as volvulus, intussusception and internal hernia.
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