Computed tomography of the abdomen showed an abnormality at the hepatic flexure (fig 1 ⇓). Oesophagogastroduodenoscopy showed no cause for the anaemia. Lisinopril and bendroflumethiazide were stopped and the postural hypotension and hyponatraemia resolved. No masses were palpable on abdominal examination.īlood tests showed iron deficiency anaemia and hyponatraemia (haemoglobin 75 g/L (normal range 115-165), mean corpuscular volume 78 fL (80-97), iron 2 µmol/L (12-26), total iron binding capacity 42 µmol/L (45-70 1 µmol/L=5.59 µg/dL), transferrin saturation (ratio of iron to total iron binding capacity) 4.76% (15-50), sodium 130 mmol/L (135-145 1 mmol/L=1 mEq/L)). This happens when gas builds up or becomes trapped in the colon. The liver is often visible near the hepatic. Similar symptoms caused by ordinary gas attacks are relieved by passing gas by mouth or by rectum. The hepatic flexure or right colic separates the ascending from the transverse colon and the splenic flexure or left colic separates the transverse and the descending colon. first described in 1910, 1 chilaiditi sign is the asymptomatic interposition of the intestine, usually a portion of the hepatic flexure of the colon, between the liver and diaphragm, whereas chilaiditi syndrome refers to clinical symptoms such as abdominal bloating, pain or anorexia developing from this phenomenon. 20), while in the region of the hepatic flexure itself the lumen is angled caudally toward the ascending colon. Accompanying these anomalies, there may be fever, bloating, abdominal cramping, or spasms of the colon. Her blood pressure was 117/54 mm Hg when lying and 52/31 mm Hg when standing. Irregularities of the bowel caused by splenic flexure syndrome (SFS) may manifest as diarrhea or as constipation. On examination she appeared cachectic with evidence of conjunctival pallor. Her son had died at 60 years of age from large bowel obstruction and perforation secondary to colon cancer. Among other drugs, she was taking lisinopril, bendroflumethiazide, and levothyroxine. Her medical history included hypertension, hypothyroidism, and anaemia (which was currently being investigated by her general practitioner). She had felt generally weak for more than a year, with weight loss of 56 lb (25.2 kg) but no change in bowel habit, dysphagia, or gastrointestinal bleeding. Keywords: Colorectal cancer, adenosquamous. She recalled standing from her chair, feeling lightheaded, and then collapsing. This case promotes the understanding of colon ASC and provides a basis for its clinical diagnosis and treatment.

Correspondence to: J Naqvi Ī 92 year old woman presented to the emergency department after collapsing at home.1University Hospital of South Manchester, Manchester M23 9LT, UK.The hepatic flexure, a normal feature in the anatomy of the gut, is the sharp bend between the ascending and transverse colon.

Sarah Duff, consultant colorectal surgeon Endoscopic view inside the hepatic flexure of a healthy colon (large intestine).

Velauthan Rudralingham, consultant gastrointestinal radiologist ,.

Gill Watts, consultant gastroenterologist ,.

Jawad Naqvi, academic foundation doctor,.

Hepatic flexture of colon