![]() This contribution summarizes benign conditions of the colon and rectum that can be detected during CTC and routine cross-sectional imaging techniques.ĭiagnostic imaging of the colon and the rectum has undergone a remarkable evolution over the last few decades. Because of the risk of perforation, these conditions are evaluated with standard cross-sectional imaging techniques. The heterogeneous group of inflammatory colonic diseases includes acute diverticular disease, colonic involvement in chronic inflammatory bowel disease, and colonic infectious and noninfectious colitis. These lesions are detected best by CT colonography, a powerful noninvasive test to evaluate the intraluminal aspect of the entire colon, both for colorectal cancer screening and incomplete colonoscopy. Polypoid as well as stenotic lesions include benign adenomatous polyps, various non-adenomatous polypoid findings, and stenotic lesions, commonly seen in chronic diverticular disease. The liver is displaced from its usual position by the colon which makes its way anteriorly (in front of the liver), and superiorly (below the diaphragm), so that if there is air within this loop it will masquearades as “free air” (Image courtesy of Ashley Davidoff M.D.Benign diseases of the colon and rectum include a heterogeneous spectrum of various neoplastic as well as nonneoplastic conditions. This axial image of the abdomen shows the colon and specifically the hepatic flexure malpositioned anterior to the liver. The liver is displaced from its usual position by the colon which makes its way anteriorly (in front of the liver), and superiorly (below the diaphragm), so that if there is air within this loop it will masquerades as “free air” (Image courtesy of Ashley Davidoff M.D.) 45765 This coronal image of the abdomen shows the colon and specifically the hepatic flexure malpositioned under the diaphragm and mimics the presence of free air under the diaphragm as noted in the above images. (Image courtesy of Ashley Davidoff M.D.) 45761Ĭhilaiditi syndrome – interposition the colon This upright iamge of the abdomen clearly shows that the air under the diapragm is part of air within the lumen of a loop of bowel in the right upper quadrant. See next image (Image courtesy of Ashley Davidoff M.D.) 45758 45759 ![]() The patient was asymptomatic and so a subsequent upright KUB was performed. This image shows a curvilinear air shadow that suggests free ar under the diaphragm. ![]() Note the fluid filled colon caused by a mucin secreting adenocarcinoma. The coronal reformat from a frail and elderly woman shows a thick walled hepatic flexure with transmural extension toward the liver. Hepatic flexure mucin secreting adenocarcinoma Occasionally an aggressive carcinoma may spread directly from the colon to the liver or gallbladder, making surgical resection difficult. The close relationship of this part of the colon with the liver and gallbladder is sometimes relevant in disease. This CT study shows a redundant complex turn of the hepatic flexure. It is commonly redundant and it may be difficult to uncoil this redundancy with a barium enema. The hepatic flexure is not always a simple 90 degree turn. It is commonly redundant and it may be difficult radiologically to uncoil this redundancy with a barium enema making it difficult to fully visualize all parts of the flexure. The beginning and end of the hepatic flexure are ill defined, but it connects the ascending colon with the transverse colon. The hepatic flexure receives its blood supply in part from the right colic vessels and in part from the middle colic vessels Normal hepatic flexure There are no defining structural changes, other than for the endoscopist trying to navigate the colon who may be able to see the dark extrinsic impression of the liver on the colon, thus marking the distinction between the end of the ascending and beginning of transverse colon. The hepatic flexure is the junction between the transverse colon and the ascending colon.
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