However, clinical features are considered to be less useful in differentiating XCG from GBC.4 On ultrasonography the common and characteristic feature of all of our patients was either thickened gallbladder wall or mass which warranted further confirmation with triphasic CT scan which confirmed gallbladder mass infiltrating into right lobe of liver in all patients and involvement of hepatic flexure
of colon in two patients with associated portal lymphadenopathy favouring GBC.
A computed tomography scan of the abdomen showed an asymmetric circumferential short segment of non-homogeneously enhanced wall thickness up to 20 mm at the hepatic flexure
and adjacent ascending colon.
Coronal (a) and axial (b) CT post-contrast portovenous images of a stricturing hepatic flexure
tumor with a prominent draining vessel [a key feature of extramural vascular invasion (red arrow), Axial CT portovenous phase images with nodal disease (green arrow) and hepatic flexure
stricturing tumor (c)
negative diagnosis for "eosinophilic enterocolitis" for each pathologist, assuming a threshold of 20 eosinophils per HPF in the ileum or rectum and 50 in the hepatic flexure
. Results were diverging with observer #1 diagnosing 8 (80%) positive and 2 (20%) negative, while observer #2 diagnosed 0 positive and 10 (100%) negative.
After six weeks of inpatient treatment and subsequent clinical improvement, a colonoscopy was performed to rule out colon cancer given the suspicious apple-core lesion noted on the CT at the hepatic flexure
. It revealed diffuse friable changes of the colonic wall extending from the cecum to the hepatic flexure
and the transverse colon (Figure 2).
Caption: Figure 2: CT abdomen pelvis day 6: air within a distended gall bladder with persistent pericholecystic fat stranding, more marked than on prior imaging and extending to involve the hepatic flexure
. New, peripherally enhancing fluid collection extending the inferior tip of the liver along the right paracolic gutter; appearances are suggestive of complicated cholecystitis with a gallbladder perforation.
The hepatic flexure
of the colon had herniated through the intercostal muscles of the eighth and ninth ribs and was lying adjacent to the fractured ribs (Fig.
The herniated organs included the liver, proximal ascending colon, proximal transverse colon, hepatic flexure
and omentum (Fig.
At appendicectomy, the appendix was noted to be arising from the hepatic flexure
of the colon.
Chilaiditi sign describes an anomalous anatomic position of the hepatic flexure
of the colon between the liver and the right diaphragm.
The adjusted prevalence ratios were as follows: 0.99 for the cecum and ascending colon, 1.21 for the hepatic flexure
and transverse colon, 0.36 for the splenic flexure and descending colon, 0.29 for the sigmoid colon, and 0.07 for the rectum.
Chilaiditi's sign is a radiographic term that is used when the hepatic flexure
of the colon is seen interposed between the liver and right hemidiaphragm.