Overview.
Subdiaphragmatic colon insertion syndrome, also known as interstitial colon syndrome, is a group of syndromes in which the colon (most often the hepatic flexure) passes from the anterior or posterior hepatic hiatus between the liver and the diaphragm, which may be asymptomatic, but can cause vague pain in the right quadrant of the ribcage, abdominal distension, and vomiting.
Etiology
The cause is not in the intestine itself, but in the prolapse and abnormal position of the liver, which is the basis for the development of the disease. It is often due to abnormal development of the liver, such as overgrown, weak, or absent ligaments, which causes the liver to move down and widen the gap between it and the diaphragm, so that the colon is embedded in between to form this disease. Congenital weakness of the diaphragm or paralysis of the diaphragm is a contributing factor to this disease. In addition, in some patients with cirrhosis, the right hepatic lobe atrophies significantly and the hepatic-diaphragmatic gap is enlarged.
Symptoms
This disease can be seen in both men and women, usually asymptomatic, part of the manifestation of epigastric discomfort, mild abdominal distension, the right upper abdomen is obvious, aggravated after meals. It is often misdiagnosed as cholecystitis or gastritis. When obstruction occurs in the embedded colon, the sudden onset of epigastric distension is often felt, and there is a sense of breath-holding and back discharge pain. Symptoms disappear after a few hours to a few days, and most of the symptoms suddenly disappear after activities.
Examination
A standing abdominal plain film shows a pneumatized colon and colonic pouch between the diaphragm and the liver (spleen).
Diagnosis
The diagnosis can be made on the basis of the clinical presentation and the findings on the standing abdominal radiograph, but it is necessary to exclude subphrenic pneumoperitoneum caused by other organic pathologies, such as perforation of the digestive tract and intestinal obstruction.
Treatment
In some cases of severe symptoms with progressive and persistent exacerbation, especially in childhood, severe symptoms, loss of appetite, and impaired growth, radical surgical intervention with immobilization of the liver and colon may be considered, which has a better prognosis.
Mild cases usually do not require treatment. Avoid excessive gas swallowing and eating food that produces too much gas, and lie flat to relieve pain episodes.