The authors certify that appropriate patient consent was obtained.If any of you has been correctly diagnosed with splenic flexure syndrome and had proper treatment for it, kindly tell me and others here. Identification of this variant will avoid unnecessary perforation of the colon during the percutaneous biopsy, left pleural aspiration, and splenectomy. Splenodiaphramatic interposition of the colon is an important anatomical variant and can be confidently identified in cross-sectional imaging. In patients with this variation, there is a risk of injury to the colon during splenectomy. Colonic perforation can cause peritonitis, colitis, and pleuritis. Percutaneous intervention procedures such as percutaneous needle biopsy of spleen or kidney, percutaneous nephrostomy, and left pleural aspiration should be cautiously performed in the patients with splenodiaphramatic interposition because of the risk of perforation of the colon. The left kidney extends from T12 to 元 vertebral bodies. The pleural recess extends up to the 10 th rib in the mid-axillary line and up to the 12 th rib posteriorly. Spleen is located anterior and medial to the left 9 th, 10 th, and 11 th ribs and separated from them by the diaphragm and the costodiaphragmatic recess of the pleura. The interposition of the colon between the spleen and diaphragm represents a clinically important anatomical variant during a certain surgical procedure and percutaneous radiological intervention. , The prevalence of retrospleinc or splenodiaphramatic interposition of the colon can be up to 0.3%. ,, Retrosplenic colon can be seen in association with renal agenesis, renal ectopia, post-nephrectomy, agenesis of the diaphragm, or congenital diaphragmatic hernias. Abnormalities in the rotation and fixation of the colon and caudal displacement of the spleen due to diseases such as emphysema can lead to malposition of the splenic flexure of the colon. Normally splenic flexure of the colon lies anterior to the inferior pole of the left kidney and is more superior, more acute, and less mobile than the hepatic flexure of the colon. This gives rise to the phrenicocolic ligament that extends from the splenic flexure of the colon to the parietal peritoneum covering the undersurface of the left dome of the diaphragm. This displaces the hindgut laterally to the left and fixes the dorsal mesentery of the splenic flexure to the posterior abdominal wall. Following a rotation of the midgut, the jejunal loops return to the abdominal cavity. Rotation and fixation of the gut follow a specific and coordinated process. Notice that the costophrenic recess is blunted and any needle positioning in the recess or kidney may transgress the colon inadvertentlyĭistal transverse colon, splenic flexure, and descending colon are developed from the hindgut. įigure 1: (a) contrast-enhanced CT of lower thorax, axial section, showing interposition of splenic flexure of colon between spleen and upper pole of left kidney (b) sagittal reformat of contrast-enhanced CT showing the relationship of splenic flexure of colon with the left posterior costophrenic recess and kidney. The superior extent of the splenic flexure of the colon reached high in the left hypochondrium, causing effacement of the left posterior costophrenic recess. CT demonstrated that the splenic flexure of the colon was interposed between the spleen and the left kidney anteriorly and left dome of the diaphragm posteriorly. Ī 77-year-old man with known hepatocellular carcinoma (HCC) underwent a computed tomography (CT) scan of the thorax and magnetic resonance imaging (MRI) of the upper abdomen for staging. In this report, we are discussing splenodiaphragmatic interposition of the splenic flexure of the colon and possible complications if unnoticed. Knowledge of such variations can aid in their detection at cross-sectional imaging and avoid unnecessary complications. Available from: Ībnormalities of rotation and fixation of the colon during embryological development cause colonic malposition some of them are of clinical importance. Splenodiaphragmatic interposition of the splenic flexure of colon.
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How to cite this URL: S Nalamolu V K, Chatterjee A. How to cite this article: S Nalamolu V K, Chatterjee A.
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