#SPLINEX FLEXTURE HOW TO#

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.

#SPLINEX FLEXTURE HOW TO#

How to cite this URL: S Nalamolu V K, Chatterjee A. Note the omental cake in the omentum toward the left side in front of the encased colon.How to cite this article: S Nalamolu V K, Chatterjee A. Note how the malignant process surrounds the splenic flexure. The process surrounding the beginning of the descending colon is caused by extension of a malignant pancreatic carcinoma into the phrenicocolic ligament along the lateral aspect of the transverse mesocolon. This is a beautiful example of the colon cutoff sign demonstrated by a single contrast barium enema in a patient with acute pancreatitis. The cutoff in this instance is quite straight, but in most patients there is usually a sharp transition from dilated transverse to decompressed descending colon. The colon cutoff sign in the splenic flexure is obvious in this patient with acute pancreatitis. As the inflammatory process spreads along this ligament it comes into contact and spreads the inflammatory process to the splenic flexure and proximal descending colon resulting in a reversible stricture caused by a combination of swelling and spasm. This ligament is called the phrenicocolic ligament because it is connected to the diaphragm (phrenic) on the one end and the colon on the other. The colon cutoff sign ( Pickhardt) is a characteristic finding in patients with pancreatitis where the inflammatory process extends along the tail of the pancreas to the left side where it comes into contact with a triangular ligament that connects the left colon to the diaphragm- just to the left of the lateral aspect of the transverse mesocolon. In this normal double contrast study, the splenic flexure has a steep climb to its mountain top position and then an almost 180 degree turn as it begins its steep descent. Note its cranial position – it is the highest point of the colon in the abdominal cavity. The splenic flexure in this single contrast barium enema is relatively short and almost a 90 degree turn. Like the hepatic flexure it can also vary in length and at its longest can be quite redundant with similar radiological difficulties to uncoil it during a barium enema. It is attached to the diaphragm by the phrenicocolic ligament. Its drainage is via the corresponding mesenteric veins into the SMV and then portal circulation. It is the embryological junction point between the midgut and hindgut, and is the watershed of two circulations so that it is the border where the circulations of the SMA and IMA meet. The splenic flexure is the junction between the transverse colon and the descending colon and is usually the most cranial portion of the colon.

Splinex flexture