Extrinsic Deformities of the Colon

Abstract

In this era of rapid technical advances in roentgenologic diagnosis, it is easy to forget what may be learned from ancient and simple methods of examination. It is easy, too, in this day of specialization within the specialty, to succumb to the temptation to divide the human anatomy into separate parts, forgetting the relation to other parts. Anatomical variations in the position of the colon, and displacement of the colon by enlarged livers, enlarged spleens, and massive pelvic tumors were demonstrated in the early days of roentgenology, but there is yet much to be learned about the pressure effects that normal and diseased viscera may exert on the barium-filled colon. The differentiation of these defects from those produced by intrinsic lesions of the colon is not always easy. No hard and fast rules can be drawn, but evaluation of filling defects must be based on a correlation of history, physical findings, roentgenologic findings, and a knowledge of anatomy and pathology. The dictum that the mucosa is not involved in extrinsic lesions is helpful, but one must be wary of his version of a normal mucosa of the colon. Often, all we can honestly do is to tell the surgeon that we do not know whether the colonic lesion is intrinsic or extrinsic, and that he must enter the abdomen prepared for a resection. Thirty years ago, Carman and Miller (1) wrote: “Displacement of any part of the colon may be produced by extrinsic tumors of every sort, including those of the liver, kidney, pancreas, spleen, uterus, and adnexa; by adhesive bands, by pregnancy, and by psoas abscess. Displacement commonly affects only those portions of the colon which are more or less movable, the hepatic flexure being occasionally, and the splenic flexure, rarely, implicated. Fixation of the cecum may be the result of appendicitis, tuberculosis, pelvic conditions, or malignancy. Cases of so-called Jackson's membrane may deform the cecum and ascending colon.” Wiese and Larimore (2), in 1932, reviewed 126 cases of extra-alimentary tumors encountered in routine examination of the gastro-intestinal tract, and discussed in detail the deformities produced by those tumors. Fleischner (3), in the same year, discussed deformity of the colon by inflammatory and neoplastic processes in the immediate vicinity of the colon, and stated that these might cause edema of the intestinal wall by blockage of lymphatics and blood vessels. He quoted one case in which there was extensive deformity of the ascending colon due to metastasis to nodes in the ileocecal angle from a sarcoma of the right kidney and ureter. Hubeny (4), in 1939, in a paper entitled “Extra-Alimentary Causes of Alimentary Filling Defects” showed several cases in which the colon was deformed or displaced by extrinsic masses. One of these was an ovarian cyst located lateral to the ascending colon and displacing it medially. In another, a cystic mass in the pancreas displaced the splenic flexure downward.