Splenic Flexure Syndrome

What is Splenic Flexure Syndrome?

Splenic Flexure Syndrome (SFS) can be defined as a form of chronic digestive disorder that is characterized by spasms of splenic flexure of colon which is caused by the trapped gas in splenic flexure or the bends of colon. The splenic flexure can be found close to the spleen and a part of the large intestine. It is a sharp bend which changes directions from the horizontal to the vertical in upper left abdomen. It does not have a primary blood supply source and hence depends on the terminal branches of the superior mesenteric artery as well as the inferior mesenteric artery.

The painful sensations and the abdominal discomfort that is experienced by patients can be quite excruciating and resemble that of a heart attack. This digestive disorder produces an excessive amount of gas that is far beyond normal levels.

Picture Source: uchospitals.edu

Splenic Flexure Syndrome Causes

There are a number of causes which can lead to the development of this syndrome. These include the following:

• Increased accumulation of gas in the gastric system is believed to be the most common factor responsible for this syndrome. When gas gets trapped within the gastrointestinal tract, it causes immense discomfort to the patient. Passing of the gas is required to bring relief to the affected individual, which can prove to be difficult for this condition.
• Another major factor responsible for this syndrome is a distended abdomen. If too much space gets accumulated in gastric area, it then leads to great discomfort. Foods that are fatty and can lead to the formation of gas can cause such a state to develop.
• Undigested food can lead to the development of excessive gas as the food is not broken down by the bacteria present in large intestine.
• Short-chained carbohydrates can lead to diarrhea and abdominal bloating as they pull water from intestinal vessel to intestinal lumen after ingestion. This leads to the formation of large amounts of gas. The foods that are classified as short chained carbohydrates include wheat, brussel sprouts, legumes, apples, sweet cherries, prunes as well as sugar-free chewing gums.
• Food poisoning may lead to diarrhea and gas production. Food poisoning occurs from bacterial infections caused by agents such as Escherichia coli, Salmonella, Campylobacter, Staphylococcus aureus, Yersinia, Clostridium perfringens, Shigella, and Vibrio cholera.
• Aerophagia or air swallowing is a process by which air enters esophagus. This might happen when an individual drinks or eats too quickly, chewing a regular gum, hyperventilation caused by anxiety, nasal blockage and mouth breathing.
• Abdominal adhesion that occurs after an abdominal surgery may block the supply of food and blood. This leads to abdominal pain and bloating.
• Splenic flexure syndrome may also be caused by ulcerative colitis. It is an inflammatory bowel disorder that involves the large intestine and initially develops in rectal area but later affects the whole of the large intestine.
• Infections such as Amoebiasis and Tuberculosis may also lead to this syndrome.
• It can also be caused by obstruction that occurs due to serious conditions like Pancreatitis and Cancer.
• Crohn’s disease is a type of inflammatory bowel disorder that affects the intestines and can develop in mouth to end of rectum. Individuals suffering from this disorder have chronic inflammations of the gastrointestinal tract anywhere within the area of digestive tract.
• Irregularities in contractions or in automatically moving the food through digestive tract may lead to the formation of small air pockets of intestinal gas.
• Intake of alcohol can lead to the entrapment of gas inside the colon.
• Complex sugars like fructose and raffinose greatly increases the chances of developing this syndrome.
• Other foods that may lead to this condition include broccoli, beans, peas, lactose, sodas, potatoes and soy beans.

Splenic Flexure Syndrome Symptoms

People with SFS mainly complain of suffering from intense abdominal discomfort, which is mostly felt around the upper parts of the abdomen. The various signs and symptoms that are commonly associated with this syndrome are mentioned below:

• Abdominal distention – This is essentially caused by increase in the amount of gas within the splenic fixture. This is accompanied by bloating, which is also a major sign for this syndrome. It is mostly triggered by an increase in the intake of fatty foods as well as gas-forming foods.
• Abdominal spasms are a common manifestation associated with this syndrome. It is also a source of major discomfort for the patients. This is most likely precipitated by formation or trapping of gas within the gastric system.
• Flatulence occurs when gas passes through the rectum. When affected by SFS, this tends to occur more frequently.
• Discomfort is felt in the left upper abdominal area. This is generally concentrated under the ribs, which may gradually radiate towards the shoulders. The pain may last only for a minute or two, or it can continue for a longer duration.

Other symptoms associated with this disorder include:

• Fever
• Bloating
• Belching
• Diarrhea
• Colon spasm
• Constipation
• Rapid heartbeats
• Abdominal cramps
• Presence of a palpable mass
• Presence of excessive amounts of gas
• Drum-like sounds emitted while tapping the upper abdominal area

Splenic Flexure Syndrome Diagnosis

There is no definite diagnostic procedure that may help the medical team to evaluate if a person is having this syndrome. The following steps may help in determining the exact factor responsible for causing the problem:

• Firstly, doctors need to study the medical history of affected individuals as a detailed review of the patient’s clinical data can allow in ruling out the other possible health conditions involving the gastrointestinal system.
• A thorough physical examination can indicate the significant symptoms present in the patient that are related to the disorder. Although it is not definitive, it still can help in the identifying the root cause of the condition.
• A 24-hour diet recall can allow noting down the patient’s overall diet regimen. This can help to determine if the diet is in any way responsible for the symptoms that are seen in the patient.
• Gastrointestinal series tests help in ruling out the possibilities of underlying GI problems. They also help in negating other factors that may be held responsible for this condition.
• X-rays can help to detect any obstructions that might be present in the gastrointestinal tract.

Splenic Flexure Syndrome Differential Diagnosis

There are numerous health conditions that show the signs and symptoms similar to that of SFS. Hence, while determining the diagnosis for this syndrome, it is necessary to differentiate it from such similar disorders. The differential diagnoses for SFS include conditions such as:

• Constipation
• Herpes Zoster
• Splenic infarct
• Sickle cell crisis
• Splenic abscess
• Kidney contusion
• Sickle cell anemia
• Spleen hematoma
• Colon diverticulitis
• Subphrenic abscess
• Perinephric abscess
• Nonspecific splenitis
• Colon adenocarcinoma
• Primary spleen sarcoma
• Splenic artery embolism
• Large bowel obstruction
• Irritable Colon Syndrome
• Splenic flexure syndrome
• Infectious mononucleosis
• Bowel hypomotility syndrome
• Intestinal or bowel obstruction
• Splenic subcapsular hematoma
• Subacute bacterial endocarditis
• Cavernous splenic hemangioma
• Splenic rupture or splenic laceration
• Congestive or chronic splenomegaly
• Costochondral slipping rib syndrome
• Kidney stones / nephrolithias / urolithiasis

Splenic Flexure Syndrome Treatment

There are no definite treatment measures for this syndrome. Treatment is mostly aimed at managing the symptoms. The following remedies are proposed for curing SFS:

• Antacids are an effective way to relieve the discomfort of the patients. It can also manage abdominal bloating. Antacids containing activated charcoal and simethicone are the ones that are mostly prescribed by the doctors. Certain antacids are more frequently recommended such as the Di-Gel and Maalox. Activated charcoal tablets can provide instant relief to the patients from gas formation.
• Apart from the above-mentioned medications, pharmacological treatment of this syndrome also includes drugs such as antispasmodic and anticholinergic agents. Antispasmodic drugs have been found to reduce the pain associated with this condition. Anticholinergic drugs can relieve the signs of intestinal spasms. Dicyclomine helps to manage pain and fecal urgency.
• Beano is an excellent drug that aids in digestion. It contains a sugar-containing enzyme which facilitates the process of digestion, thereby easing any difficulties associated with it.
• Metoclopramide is sometimes prescribed to the patients to ease abdominal discomfort and promote motility.
• Passing of stool and gas is another way of relieving the pain and discomfort that is associated with this condition.
• Modification of the diet is an essential step in the treatment of this disorder. Foods that may lead to formation of gas should be avoided. One should also limit the intake of foods that contain high quantities of fats as well as foods that comprises lactose, raffinose and fructose. Patients are also recommended to drink lactose-reduced milk instead of the common milk that is available in the market.
• The affected individuals should also avoid swallowing air in order to reduce or eliminate gas production. It is recommended that the patients take probiotic supplements prior to eating. The food should be slowly and properly chewed before being swallowed as this helps in effective digestion.
• Patients should also maintain good posture and avoid hunching to prevent formation of air traps.

Splenic Flexure Syndrome Diet

Diet plays an important role in preventing building up of gas and also retention of liquids in the body. The foods that naturally lead to excessive gas formation should be avoided under all circumstances. It is advisable to reduce the quantities of sodium from the diet and increase the intake of potassium. Sodium helps in attracting water to cells while potassium draws the water out of cells. Optimal balance of water can be maintained by sticking to a diet that is low on sodium and high on potassium. Foods that are rich on potassium include root vegetables and banana.

Intolerance to lactose as well as other dairy products should be detected and replaced with products that are lactose free. Elimination diet is recommended to identify vulnerability to certain foods. A lactose-free diet can be considered for 1 week.

A fiber diet or dietary supplements may help in improving the general signs and symptoms, although a number of patients might complain of distention and bloating with a high fiber diet.

Patients experiencing constipation should switch to a diet consisting of larger amounts of fluids.

Splenic Flexure Syndrome Prognosis

The overall outcome of the treatment for this condition is mostly positive once the underlying factors leading to the syndrome becomes known. Treatment becomes much easier if the disease is diagnosed early. The symptoms can be easily reduced at the earlier stages.