Anomalous rotation and fixation of the left colon: Embryogenesis and surgical management

Abstract

A case of anomalous location of the splenic flexure and distal colon associated with a left paraduodenal hernia is reported, and its surgical significance discussed. It is believed to be the sixth such case reported and the first in which normal anatomic relationships were restored. The rarity of such true anomalies of development of the posterior retention band and the resultant anomalous location of the splenic flexure and distal colon is noted. Clinical symptoms seem related to bowel obstruction and diagnosis is by barium enema. These cases should be differentiated on an embryologic basis from the much more common anomaly of displacement of the descending and sigmoid colon, with a normally developed posterior retention band and a normally located splenic flexure. The surgical repair requires a knowledge of the embryogenesis of the anomaly so that after freeing the abnormal attachments the bowel can be properly rotated and repositioned. Resection should not be necessary.