Dolichocolon revisited: An inborn anatomic variant with redundancies causing constipation and volvulus

Abstract

The objective of this review is to examine whether a redundant colon gives rise to symptoms like constipation and volvulus. In 1820, Monterossi made drawings of colons with displacements and elongation of the colon found during autopsy. In 1912, Kienböeck first visualized a redundant colon using bismuth, and Lardennois and Auborg named the anatomic variant dolichocolon in 1914. The criteria were later: A sigmoid loop rising over the line between the iliac crests, a transverse colon below the same line and extra loops at the flexures. The incidence of dolichocolon is 1.9%-28.5%. Dolichocolon seems to be congenital, as fetuses, newborns, and infants exhibit colonic redundancies. Studies have identified a triade of constipation, abdominal pain, and distension. Colon transit time was recently shown to increase significantly with increased number of redundancies, which increases abdominal pain, bloating and infrequent defecation. The diagnosis of dolichocolon is established by barium enema or CT-colonography. Treatment is conservative, or surgical in case of volvulus or refractory constipation.

Keywords: Dolichocolon, Colon elongatum, Functional gastrointestinal disorders, Constipation, Volvulus

Core tip: Dolichocolon is an inborn anatomic variant, where redundancies may be located in the right, middle and left part of the colon and at the flexures. This review investigated the literature on dolichocolon. The prevalence is not known. The incidence is 1.9%-28.5% in patient series. The dominating symptoms of dolichocolon are constipation, abdominal pain and volvulus. Colon transit time is prolonged and increases significantly with increased number of redundancies, which increases abdominal pain, bloating and infrequent defecation. The diagnosis is established by a barium enema or CT-colonography. Treatment is conservative, or surgical in case of volvulus or refractory constipation.