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Brown KK, Jolley MC, Kocay DA. Appendicitis mimicry of dolichocolon. J Surg Case Rep 2023; 2023:rjad565. [PMID: 37854520 PMCID: PMC10581708 DOI: 10.1093/jscr/rjad565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 09/24/2023] [Indexed: 10/20/2023] Open
Abstract
Dolichocolon is an under-reported, under-diagnosed etiology of chronic constipation that is often overlooked as being a primary diagnosis. We present a case of an undiagnosed dolichocolon in a young adult female whose initial presentation was concerning of appendicitis. Eventually, the patient underwent a subtotal colectomy as a definitive treatment for chronic constipation. Dolichocolon is an anatomical variant that can have severe lifelong consequences, such as chronic constipation, which greatly affects a patient's quality of life and overall health if undiagnosed. The purpose of this case report is to raise awareness among the surgical community regarding the significance of early dolichocolon diagnosis, prevent misdiagnosis, and ultimately improve patient outcomes, including reducing complications associated with chronic constipation.
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Affiliation(s)
- Kayla K Brown
- Graduate Medical Education, General Surgery Residency Program, St. David’s South Austin Medical Center, Austin, TX 78704, United States
| | - Mercedes C Jolley
- Graduate Medical Education, General Surgery Residency Program, St. David’s South Austin Medical Center, Austin, TX 78704, United States
| | - Dean A Kocay
- St. David’s South Austin Medical Center, Austin, TX 78704, United States
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Zarokosta M, Piperos Τ, Zoulamoglou M, Theodoropoulos P, Nikou E, Flessas I, Boumpa E, Bonatsos V, Noussios G, Mariolis-Sapsakos T. Anomalous course of the sigmoid colon and the mesosigmoid encountered during colectomy. A case report of a redundant loop of sigmoid colon. Int J Surg Case Rep 2018; 46:20-23. [PMID: 29655020 PMCID: PMC6000771 DOI: 10.1016/j.ijscr.2018.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 02/22/2018] [Accepted: 02/24/2018] [Indexed: 01/14/2023] Open
Abstract
Introduction Sigmoid colon constitutes a part of the large intestine that presents several congenital anatomic variations. In particular, the presence of a redundant loop of sigmoid colon is of tremendous importance for surgeons, obstetricians and radiologists, since it is closely related to multiple pathological conditions and functional implications of the neighboring anatomical structures. PRESENTATION OF CASE An unusual anatomic variation in position and length of the sigmoid colon and its mesocolon was unexpectedly detected during right hemicolectomy to a 67-year-old Caucasian male patient due to colon cancer. The operation was uneventful. A meticulous review of the literature was conducted as well. DISCUSSION A redundant loop of sigmoid colon may go unnoticed or it might lead to urinary, digestive and vascular complications. Its presence is associated with acute and chronic pathological conditions, sigmoid volvulus and serious confusions in radiological diagnosis and instrumentation. CONCLUSION Surgeons' thorough knowledge concerning this rare anatomic variation is fundamental and crucial in order to establish a correct diagnosis and assert the appropriate management when performing operations including pelvis and abdomen.
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Affiliation(s)
- Maria Zarokosta
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Athens, Greece.
| | - Τheodoros Piperos
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Athens, Greece
| | - Menelaos Zoulamoglou
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece
| | - Panagiotis Theodoropoulos
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece
| | - Euthumios Nikou
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece
| | - Ioannis Flessas
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Athens, Greece
| | - Eleni Boumpa
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Athens, Greece
| | - Vasileios Bonatsos
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece
| | - George Noussios
- Department of Physical Education and Sports Sciences, "Aristotles", University of Thessaloniki, Serres, Greece
| | - Theodoros Mariolis-Sapsakos
- University Department of Surgery, General and Oncologic Hospital of Kifissia, "Aristotles", Athens, Greece; Anatomy and Histology Laboratory, School of Nursing, University of Athens, Athens, Greece
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Raahave D. Dolichocolon revisited: An inborn anatomic variant with redundancies causing constipation and volvulus. World J Gastrointest Surg 2018; 10:6-12. [PMID: 29492185 PMCID: PMC5827035 DOI: 10.4240/wjgs.v10.i2.6] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/24/2018] [Accepted: 01/29/2018] [Indexed: 02/06/2023] Open
Abstract
The objective of this review is to examine whether a redundant colon gives rise to symptoms like constipation and volvulus. In 1820, Monterossi made drawings of colons with displacements and elongation of the colon found during autopsy. In 1912, Kienböeck first visualized a redundant colon using bismuth, and Lardennois and Auborg named the anatomic variant dolichocolon in 1914. The criteria were later: A sigmoid loop rising over the line between the iliac crests, a transverse colon below the same line and extra loops at the flexures. The incidence of dolichocolon is 1.9%-28.5%. Dolichocolon seems to be congenital, as fetuses, newborns, and infants exhibit colonic redundancies. Studies have identified a triade of constipation, abdominal pain, and distension. Colon transit time was recently shown to increase significantly with increased number of redundancies, which increases abdominal pain, bloating and infrequent defecation. The diagnosis of dolichocolon is established by barium enema or CT-colonography. Treatment is conservative, or surgical in case of volvulus or refractory constipation.
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