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LETTER TO THE EDITOR |
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| Year : 2012 | Volume
: 17
| Issue : 1 | Page : 43 |
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Sigmoid colon in right iliac fossa in children
Jigyasa Pandey1, Anand Pandey2, Jiledar Rawat2
1 Department of Radiodiagnosis, Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, India
2 Department of Pediatric Surgery, CSM Medical University (Formerly KG's Medical College), Lucknow, Uttar Pradesh, India
| Date of Web Publication | 22-Dec-2011 |
Correspondence Address:
Anand Pandey
Department of Pediatric Surgery, CSM Medical University (Formerly KG's Medical College), Lucknow - 226 003, Uttar Pradesh
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-9261.91089
How to cite this article:
Pandey J, Pandey A, Rawat J. Sigmoid colon in right iliac fossa in children. J Indian Assoc Pediatr Surg 2012;17:43 |
Sir,
We read with interest the article by Saxena et al. [1] on the position of sigmoid colon. Some benefits of assessing the position have been described. We would like to draw attention towards some reservations.
In today's world, X-ray is definitely the preliminary test, but the diagnosis does not rely only on it. It appears that the authors want to convey that diagnosis is to be made only by X-ray. In Hirschsprung's disease, the rectum is devoid of air, [2] and the clinical history is also suggestive of delayed passage of meconium. Hence, it is highly unlikely that the entity can be confused with cecal obstruction. Moreover, definitive diagnosis is made by contrast studies.
X-ray in not the preferred modality when intussusception is suspected. [3] It can only suggest it, which is mostly confirmed by either a contrast study or an ultrasonography of the abdomen.
Plain radiography is often nondiagnostic for malrotation. [4] Moreover, instead of relying on the cecal gas, in the contrast study, initially, the position of dudenojejunal flexure is looked for. In case of midgut volvulus, the abdomen is gasless. Besides, there is a definite history of bilious vomiting.
Appendicitis usually presents with umbilical or right iliac fossa pain. It would be nice to know the percentage of patients diagnosed as appendicitis only on the basis of the plain radiography.
As regard to cecostomy, none of the three papers, which have been cited, has reported the complication of accidental injury to sigmoid colon. Besides this, proper abdominal evaluation is done before cecostomy is performed. [5] Hence, the likelihood appears to be minimal. A long-term prospective study in this regard can answer this query.
As all patients who underwent contrast enema had large bowel disease, it can be speculated that the colon being redundant, instead of remaining at its normal site, occupied more space than it would normally have required. As ethical concerns refrained the authors to ascertain the position of the colon in normal children, it cannot be exactly extrapolated to the general population.
 References | |  |
| 1. | Saxena AK, Sodhi KS, Tirumani S, Mumtaz HA, Rao KL, Khandelwal N. Position of a sigmoid colon in right iliac fossa in children: A retrospective study. J Indian Assoc Pediatr Surg 2011;16:93-6. 
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| 2. | Teitelbaum DH, Coran AG. Hirschsprung's disease and related neuromuscular disorders of the intestine. In: Grosfeld JL, O'Neill JA Jr, Coran AG, Fonkalsrud EW, editors. Pediatric Surgery. 6 th ed. Pennsylvania, PA: Mosby Elsevier; 2006. p. 1514-59.
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| 3. | Ein SH, Daneman A. Intussusception. In: Grosfeld JL, O'Neill JA Jr, Coran AG, Fonkalsrud EW, editors. Pediatric Surgery. 6 th ed. Pennsylvania, PA: Mosby Elsevier; 2006. p. 1313-41.
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| 4. | Smith SD. Disorders of intestinal rotation and fixation. In: Grosfeld JL, O'Neill JA Jr, Coran AG, Fonkalsrud EW, editors. Pediatric Surgery. 6 th ed. Pennsylvania, PA: Mosby Elsevier; 2006. p. 1342-58.
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| 5. | Chait PG, Shlomovitz E, Connolly BL, Temple MJ, Restrepo R, Amaral JG, et al. Percutaneous cecostomy: Updates in technique and patient care. Radiology 2003;227:246-50.
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