Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

RADIOLOGICAL QUIZ
Year
: 2001  |  Volume : 11  |  Issue : 1  |  Page : 39--40

Radiological quiz - abdomen


MK Dwivedi, L Dewangan, G Kaur 
 Department of Radiodiagnosis, JLN Hospital, Bhilai, India

Correspondence Address:
M K Dwivedi
Department of Radiodiagnosis, JLN Hospital, Bhilai
India




How to cite this article:
Dwivedi M K, Dewangan L, Kaur G. Radiological quiz - abdomen.Indian J Radiol Imaging 2001;11:39-40


How to cite this URL:
Dwivedi M K, Dewangan L, Kaur G. Radiological quiz - abdomen. Indian J Radiol Imaging [serial online] 2001 [cited 2019 Nov 17 ];11:39-40
Available from: http://www.ijri.org/text.asp?2001/11/1/39/28311


Full Text

An eighteen-years-old boy presented with complaints of pain in abdomen off and on for a period of two months. He was operated for a trial septal defect in 1990.

Barium studies and CT scan were performed [Figure 1],[Figure 2].

 View Answer

 Radiological Diagnosis



Polyspenia Syndrome

Barium meal follow-through studies show the stomach under the right hemidiaphragm, and the duodenal bulb ipsilateral to the stomach with an "S" shape sweep of duodenum [Figure 1]a. The jejunal loops are seen in the left half of the abdomen, with normal position of the ileocaecal junction. Barium enema reveals that the sigmoid and descending colon are ipsilateral to the stomach (right of spine) with a part of the ascending colon parallel to the transverse colon [Figure 1]B. The cecum and remaining ascending colon are medial to the descending colon [Figure 2].

Contrast enhanced CT shows the liver in midline with the gall bladder in the central position. The stomach and multiple splenules supplied by the splenic artery are seen on the right side [Figure 2]a. The pancreas is short and round and the inferior vena cava is on the left of the spine [Figure 2]a. The lower section reveals a double inferior vena cava seen below the level of the renal veins [Figure 2]b.

Selective abdominal arteriography was performed, which revealed a normal course of the superior mesenteric artery. Inferior mesenteric artery angiography showed long sigmoidal arteries lying to the right of the spine, instead of the left [Figure 3].

Polysplenia syndrome is a situs ambiguous abnormality characterized by a number of individual splenules with bilateral left-sidedness [1],[2],[5]. In most cases the liver is seen on the left, (the right and left lobes of the liver are equal in size) and the stomach on the right side [2],[4].

A short pancreas is seen due to agenesis of the dorsal pancreas. Only the part which develops from the ventral pancreas i.e. head and uncinate process, is present [3]. As both spleen and pancreas develop in the dorsal mesogastrium, concomitant anomalies of both are seen.

Abnormalities of malposition of intestine are of two types [1],[2]

1. Non rotation of midgut _ In this, the stomach is on the right with duodenum and small intestine on the left and the duodenum forming a horizontal `S'. The entire colon is ipsilateral to the stomach. In our patient too, non-rotation of the midgut was seen.

2. Reversed rotation of gut _ In this, the pylorus and duodenum lie on the right side of the spine with the duodenum forming a backward `C'. The small bowel is ipsilateral to the stomach with the ileocecal junction in the left lower quadrant. The entire colon is contralateral to the stomach.

Bilateral superior vena cavae are present with an interrupted inferior venacava i.e. between the renal vein and hepatic vein. The inferior vena cava is interrupted by an enlarged azygos continuation and there is absence of the hepatic segment of the inferior vena cava [1],[4]. In our case neither of these caval abnormalities was seen. The boy had a double inferior vena cava below the level of the renal veins which is due to persistence of both subcardinal and supracardinal veins embryologically below the level of the kidney [6],[7].

The polysplenia syndrome has a common celiacomesenteric trunk [1]. The superior mesenteric artery jejunal branches can be seen on the right side of the abdomen reflecting malrotation of the small bowel [1]. Previously reported literature suggests a normal course and branches of the inferior mesenteric artery, but in our patient, there was right-sided origin of the sigmoid arteries.

References

1Vaughan TJ, Hawkins I, Elliott LP. Diagnosis of Polysplenia syndrome. Radiology 1971;101:511-518
2Moller J, Amplatz K, Wolfson J. Malrotation of bowel in patients with congenital heart disease and associated splenic anomalies. Radiology 1971; 99: 393-398.
3Herman TE, Siegeal MJ. Polysplenia syndrome with congenital short pancreas. AJR 1991; 156: 799-800.
4Tonkin ID, Tonkin AK. Visceroatrial situs abnormalities: Sonographic and CT appearance. AJR 1982; 138: 509-515.
5Randall PA, Moller JH. Spleen and congenital heart disease. AJR 1973; 119: 551-559.
6Sadler TW. Cardiovascular System. In: Langman's Medical embryology, 6 thsub ed. Baltimore: Williams and Wilkin, 1990:219-220.
7Hemingway AP, Allison D. Venography. In: Grainger, Allison D, ed. Diagnostic radiology, 3 rdsub ed. New York: Churchill Livingstone, 1997: 2430-2433.