Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Mar;99(3):207-209.
doi: 10.1308/rcsann.2016.0298. Epub 2016 Sep 23.

Anatomical siting of the splenic flexure using computed tomography

L Meecham  1 , A Brookes  1 , Caw Macano  1 , T Stone  1 , M Cheetham  1
Affiliations

Anatomical siting of the splenic flexure using computed tomography

L Meecham et al. Ann R Coll Surg Engl. 2017 Mar.

Abstract

INTRODUCTION Often, left-sided colorectal surgery requires splenic flexure mobilisation (SFM) to allow a tension-free anastomosis to be carried out. This step is difficult and not without risk. We investigated a system of anatomical siting of the splenic flexure using computed tomography (CT). METHODS The Shrewsbury Splenic Flexure Siting (SSFS) system involves siting of the splenic flexure using the vertebral level (VL) as a reference point. We asked three surgical registrars (SRs) to analyse 20 CT scans of patients undergoing colonic resection to ascertain the anatomical site of the splenic flexure using the SSFS system. The distance from the centre of the vertebral body to the lateral edge (CVBL) of the splenic flexure was measured, as was the distance from the centre of the vertebral body to the inner abdominal wall (CVBI) along the same line, on axial images. RESULTS VL assessment demonstrated substantial inter-observer agreement with a kappa (κ) value of 0.742 (95% confidence interval (CI), 0.463-0.890). CVBL and CVBI demonstrated very strong inter-observer agreement (CVBL: κ = 0.905 (95% CI, 0.785-0.961); CVBI: 0.951 (0.890-0.979) (p<0.001). Overall, there was strong correlation between assessments by all three SRs across the three variables measured. CONCLUSIONS The SSFS system is an accurate method to site the splenic flexure anatomically using CT. We can use the SSFS system to develop a validated scoring system to help colorectal surgeons assess the difficulty of SFM.

Keywords: Colorectal surgery; Computed tomography; Splenic flexure; Vertebral level.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Different vertebral levels on a coronal view of a vertebral body
Figure 2
Figure 2
Coronal image aligned on vertebral bodies
Figure 3
Figure 3
Axial image demonstrating a splenic flexure (circle)
Figure 4
Figure 4
Coronal image with bar corresponding to the level of a splenic flexure on an axial image
Figure 5
Figure 5
Axial image used for measuring the distance from the centre of the vertebral body to the lateral edge (CVBL)
Figure 6
Figure 6
Axial image used to measure the distance from the centre of the vertebral body to the inner abdominal wall (CVBI)
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Kye BH, Kim HJ, Kim HS, Kim JG, Cho HM. How much colonic redundancy could be obtained by splenic flexure mobilization in laparoscopic anterior or low anterior resection? Int J Med Sci 2014; : 857–862. - PMC - PubMed
    1. Sammour T, Kahokehr A, Srinivasa S, Bissett IP, Hill AG. Laparoscopic colorectal surgery is associated with a higher intraoperative complication rate than open surgery. Ann Surg 2011; : 35–43. - PubMed
    1. Wang JK, Holubar SD, Wolff BG et al. . Risk factors for splenic injury during colectomy: a matched case control study. World J Surg 2011; : 1,123–1,129. - PubMed
    1. Malek MM, Greenstein AJ, Chin EH et al. . Comparison of iatrogenic splenectomy during open and laparoscopic colon resection. Surg Laparosc Endosc Purcutan Tech 2007; : 385–387. - PubMed
    1. Akiyoshi T, Kuroyanagi H, Oya M et al. . Factors affecting difficulty of laparoscopic surgery for left-sided colon cancer. Surg Endosc 2010; : 2,749–2,754. - PubMed