Variations in the disposition of colon are developmental in origin. Interruption of typical locations may lead to a variety of acute and chronic pathological conditions. Here we report an unusual case of abnormal position of descending colon with right-sided sigmoid colon observed in a 70-year old male cadaver during the routine dissections for undergraduate medical students. In the present case, the descending colon crossed the vertebral column at L4 level to reach the right pelvic brim to continue as right sided sigmoid colon. Awareness of this finding is of crucial significance when performing procedures like percutaneous gastrotomy and radiologically guided entrostomy as it can lead to fatal sepsis in patients who undergo minimally invasive procedures.
3. sigmoid colon was observed in a 70-year old thin and short
statured female cadaver. The descending colon which
measured about 31 cm started at the splenic flexure of left
hypochondrium and crossed to the right side at the level of L4
level to reach the right iliac fossa to continue as the sigmoid
colon at the right pelvic brim (Figs. 1 and 2). The pelvic colon
measured about 6 cm long and began at the right pelvic brim
to descend along the right side of sacrum to meet at rec-
tosigmiod junction at the level of third sacral vertebra. The
average lengths of ascending and transverse colon were
11 cm and 24 cm respectively which was shorter when
compared to the normal. On observation, the descending
colon also exhibited segmental narrowing of lumen or stric-
ture along its length. The small intestine appeared to be
normal and there were no signs of surgical removal of any
parts of small intestine. The branches of inferior mesenteric
artery supplied the sigmoid colon.
3. Discussion
Variations in the length and disposition of colon are devel-
opmental in origin and interruptions in various locations
may lead to variety of acute and chronic pathological con-
ditions.2
One of the variations reported is right-sided sigmoid
colon. Elongation and displacement of sigmoid colon to the
right side has been reported by Kantor in his radiological
studies.3
Fiorella et al., in 1991 reported that the sigmoid
colon is often normally positioned within the right lower
quadrant in young children.4
In 2012, redundancy of loops of
descending colon crossing the great vessels of abdomen with
a right sided descending colon had been reported.5
In 2012,
Nayak et al. reported an excessively long sigmoid colon with
an inverted U shaped loop in front of descending colon and
left kidney.6
In 2012, Chandrika et al. reported a case where
the sigmoid colon began in the right iliac fossa and crossed
the right pelvic brim and reached the left side of sacrum.7
The current case is unique as the descending colon crossed
the midline at L4 level to the right with segmental narrowing
of lumen accompanied with the short length of sigmoid colon
on the right side.
During the 10th week of intrauterine development, in-
testines return back to the abdominal cavity after the physi-
ologic midgut herniation. The small intestine returns first and
occupies the central part of abdomen. As the large intestine
returns, it undergoes a further 180-degree counterclockwise
rotation to occupy the right side of abdomen.8
The current
case remains unique because the descending colon crossed
the midline at L4 level fusing with the left layer at root of
mesentery and crossing abdominal aorta and inferior ven-
acava. This course might have happened due to a secondary
rotation of large intestine while the primary rotation was
occurring in the small intestine. Or the primary position
occupied by sigmoid colon in the lower right quadrant below
the age of 5 years would have been retained in this case.
A malpositioned sigmoid colon can pose problems for
interventional radiologists and surgeons as it might lead to
confusions in investigation, diagnosis and intervention.
Presence of gas in the right sigmoid loop in a plain radiograph
can cause problems during evaluation as it can be mistaken
Fig. 1 e Disposition of descending colon (DC) with sigmoid
colon. Note the abnormal crossing of descending colon and
right sided sigmoid colon.
Fig. 2 e Abnormal disposition of descending colon (DC) and
sigmoid colon after the retraction of intestine. Arrow
indicates the line of fusion of descending colon with left
layer of root of mesentery.
a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e32
Please cite this article in press as: Cherian SB, Gandhalam AJ, Abnormal position of descending colon with right-sided sigmoid
colon and its clinical significance, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.07.012
4. for cecal gas which is an important index for appendicitis and
intussusception. Conscious awareness of this finding is
important for clinicians while performing procedures like
radiologically guided entrostomy and percutaneous
cecostomies.
Conflicts of interest
All authors have none to declare.
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a p o l l o m e d i c i n e x x x ( 2 0 1 4 ) 1 e3 3
Please cite this article in press as: Cherian SB, Gandhalam AJ, Abnormal position of descending colon with right-sided sigmoid
colon and its clinical significance, Apollo Medicine (2014), http://dx.doi.org/10.1016/j.apme.2014.07.012