Vrozené vývojové vady trávicí trubice představují komplikovanou problematiku týkající se řady lékařských odvětví. Cílem tohoto příspěvku je prezentovat dva případy náhlého úmrtí dětí v důsledku volvulu a hemoragické infarzace střeva zapříčiněných vrozenou vývojovou odchylkou střeva – mesenterium commune. Při provádění pitev se v praxi s podobnými případy setkáváme zřídka, v klinické i soudně-lékařské praxi je ovšem nutné myslet na přítomnost malpozice střeva jako na možnou příčinu náhlé příhody břišní.

Congenital anomalies of the digestive system represent a complicated topic concerning many medical specializations. The goal of this article is to describe two cases of children with mesenterium commune. First was an infant (5.5 months old female) who died shortly after being admitted to hospital with acute bronchitis, vomiting and diarrhoea. The autopsy revealed the cause of death – volvulus of the entire small intestine and the first portion of the large intestine with haemorrhagic infarsation of the intestinal wall in an infant with congenital anomaly of intestinal fixation – mesenterium commune. Second case was a 2. 5 years old female after two heart surgeries, with pulmonary hypertension, who died suddenly at home. The cause of death was volvulus of a portion of the small intestine with haemorrhagic infarsation of the intestinal wall and also mesenterium commune. Congenital malpositions of the intestine originate due to malrotation and malfixation of the intestine during prenatal and early postnatal period. This wide range of the individual’s developmental disorders always result in a condition where the topographical findings in the abdominal cavity are not as commonly found. Abnormally positioned intestines cannot develop a normal mesentery and are prone to volvulus, which represents the most serious complication with acute abdominal symptoms and when diagnosed late, it can lead to sudden death. Whilst performing autopsies such cases are rarely seen. However in forensic medicine and also in clinical practice it is important to consider intestinal malposition as a cause of acute abdomen.

Ústav soudního lékařství Fakultní nemocnice u sv Anny v Brně a Lékařské fakulty Masarykovy univerzity Brno

Two sudden deaths of chidren with mesenterium commune – a case report