Anatomical siting of the splenic flexure using computed tomography

Area of Science:

• Colorectal Surgery
• Surgical Anatomy
• Medical Imaging

Background:

• Left-sided colorectal surgery often necessitates splenic flexure mobilization (SFM) for tension-free anastomosis.
• SFM is a technically challenging and potentially risky surgical step.

Purpose of the Study:

• To investigate the Shrewsbury Splenic Flexure Siting (SSFS) system for anatomical localization of the splenic flexure using computed tomography (CT).
• To assess the accuracy and inter-observer reliability of the SSFS system in identifying the splenic flexure's position.

Main Methods:

• The SSFS system utilizes vertebral level (VL) as a reference point for splenic flexure siting.
• Three surgical registrars analyzed 20 CT scans, measuring vertebral level (VL), distance from vertebral body to splenic flexure edge (CVBL), and distance to abdominal wall (CVBI).

Main Results:

• VL assessment showed substantial inter-observer agreement (κ = 0.742).
• CVBL and CVBI measurements demonstrated very strong inter-observer agreement (κ = 0.905 and κ = 0.951, respectively).
• Strong correlation was observed between all three registrars' assessments across the measured variables.

Conclusions:

• The SSFS system provides an accurate method for anatomical splenic flexure siting via CT.
• The SSFS system can be developed into a validated scoring system to help colorectal surgeons evaluate the difficulty of SFM.