There are a few different theories about what causes splenic flexure syndrome, but the most likely cause is a combination of anatomic and functional factors. In some cases, over-the-counter or prescription medications may be necessary to relieve symptoms. Splenic flexure syndrome is not a serious condition and can be treated with lifestyle changes, such as eating a high-fiber diet and avoiding foods that cause gas. The kink can cause partially obstructed bowel movements and may also trap gas and fluid in the intestine. The syndrome occurs when the colon becomes twisted or kinked at the splenic flexure, which is the point where the colon bends near the spleen. Lardennois describes a most easy method of mobilization of this portion of the colon.Splenic flexure syndrome is a condition that may cause abdominal pain, bloating and gas. Several points in technic, if followed, make this an almost bloodless operation. In all but the case of the very thin individual, a subcostal oblique incision or the transverse incision, as recommended by Desmarest, is best. The operative incision should allow wide exposure. A preliminary cecostomy should always be performed to restore muscular tone of the large bowel proximal to the carcinoma and to relieve the post-operative distention so often attendant on large bowel surgery. In consideration of the operative technic, certain salient points are stressed. With improvement in technic the mortality has dropped in the last ten years from 60 to 16 per cent. The prognosis is good in uncomplicated cases provided the patient withstands operation. The most dangerous and common complication is perforation with abscess formation at the carcinomatous area, as shown in several cases of Hartwell's series. Obstipation, with pain over the cecum due to distention, and symptoms referable only to the obstipation are the rule until the case progresses to sub-obstruction requiring a physician's attention. Uncomplicated, the symptoms are those of gradually increasing constipation, rare diarrhea, almost never bloody stools, and often no loss of weight. More rarely, carcinoma at the splenic angle occurs as a malignant degeneration of polyps in this area.īecause of the nature of the lymph drainage in this locality to the mesenteric lymph nodes lying so close to the flexure and through the suspensory ligament of the splenic angle, the process, unless rapidly malignant, may be checked early and is relatively amenable to surgical procedures.
However, it has been reported as of a rapidly fungating type, following mucous colitis ulcers.
As a rule it is of a scirrhous, adenocarcinomatous, slowly growing, slowly metastasizing, ring-constricting type. Carcinoma of the splenic angle is consistently one of the rarest of colon carcinomata, that of the descending colon alone being more rare. The etiology is usually considered as traumatic. American literature for the most part deals only with statistics on this subject. The French surgeons, so skilled in colectomies, naturally have added much to the surgical technic. Hartwell presents an exhaustive study of this subject, based on six cases. The literature reviewed for the past twenty years includes statistics concerning splenic flexure carcinoma among other carcinomatous conditions of the large bowel, but very few articles deal with carcinoma of this particular locality per se. The object of this paper is to present the roentgenological diagnosis of this relatively rare condition and to discuss the salient points in etiology and symptomatology, with an outline of the surgical treatment based on a review of the different methods described in the literature.
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