What is Splenic Flexure Syndrome?
This condition is referred to as a chronic digestive disorder wherein spasms of the splenic flexure of the colon occur. These spasms are brought about by the gas that is trapped in the splenic flexure (bends of the colon). 
What is Splenic Flexure?
The splenic flexure is a sharp bend that is located in the abdomen, particularly, between the transverse and descending colon. The bend in the colon is a normal structure of the colon. Another name that is given to the splenic flexure is left colic flexure. 
Picture 1: Location of Splenic Flexure
Splenic Flexure Syndrome Causes
1. Excessive gas accumulation in the gastrointestinal tract (GI tract)
The most common cause of splenic flexure syndrome is the increased trapping of air or gas accumulation in the GI tract. The air that is trapped inside causes the feeling of discomfort . In order for the patient to have relief from the discomfort, passing of gas is needed, but in this condition, the patient experiences difficulty in doing so .
2. Abdominal Distention
- When too much space accumulates in the gastric area, this leads to feeling of discomfort. Foods which are fatty and gas-producing may lead to abdominal distention.
- The excessive gas may also be caused by undigested food. This results when the large intestine was not able to fully digest the food that has been eaten by the patient.
- Aerophagia: Also known as air swallowing, is the process wherein the air enters esophagus. Eating or drinking quickly, chewing a regular gum, nasal congestion, mouth breathing, and hyperventilation may all contribute to the occurrence of this condition. 
3. GI disorders
- Ulcerative Colitis: This is an inflammatory bowel disease which affects the lining of the colon, particularly the large intestine. It usually occurs in the rectum and lower part of the colon, but it may later on affect the whole colon.
- Crohn’s disease: It is a chronic inflammatory disease of the lining of the gut.
- Irregularities in peristalsis or moving of through the digestive tract. This condition results to the formation of small air pockets of the intestinal gas.
- Food poisoning: This is usually brought by bacterial agents such as Salmonella, Staphylococcus, Clostridium, and E. Coli. When these bacterial agents enter the digestive tract, this may result to diarrhea and gas production. [4, 5, 6]
4. Abdominal adhesion
Usually, after an abdominal surgery is performed on the patient, the supply of food and blood to the digestive tract is affected. This may lead to abdominal fullness and pain. 
- Other unidentified infections: may cause irritation to the intestinal lining [3, 4]
- Resulting from cancer
- Pancreatitis [4, 7]
7. Twisting of the colon
- Volvulus 
- Short-chained carbohydrates: These are foods which can pull water from the vessels of the intestine to the lumens after ingestion. As a result, it causes gas formation which may also lead to diarrhea and abdominal bloating. Examples of short chained carbohydrates are: legumes, apples, prunes, brussel sprouts, sweet cherries, what, and sugar free bubble gums.
- Complex carbohydrates: These increase the likelihood of developing splenic flexure syndrome. Complex carbohydrates include raffinose and fructose.
- Other gas-forming foods: potatoes, sodas, soybeans, peas, lactose, broccoli,and wheat.
- Alcoholic drink intake: also increases gas formation [4, 8]
Splenic Flexure Syndrome Symptoms
1. Abdominal pain
- The most common symptom of splenic flexure syndrome is the abdominal pain which is usually located at the left upper abdominal quadrant. Patients usually point it to be occurring beneath the ribs and may radiate upward towards the left chest.
- Sometimes, the radiating abdominal pain is mistaken to be caused by heart attack due to the location where the pain is occurring.
- The abdominal pain is described to be so severe and can last for minutes. This can even recur many times for weeks and months. [2, 9]
2. Abdominal spasms
This is a common occurrence in patients with this condition that causes their discomfort. This is usually triggered by gas formation in the gastric system. 
3. Abdominal distention
- Accompanied with bloating, and is caused by increased intake of fatty and gas-forming foods.
- Major sign of the splenic flexure syndrome 
These two may occur when the syndrome becomes uncontrolled. 
This is a result of increased frequency of gas passing through the rectum. 
6. Other symptoms:
- Tachycardia: Increased heart rate
- Stool Changes: changes in the shape in size
- Abdominal fullness or bloated feeling
- Drum-line sound in percussing the upper abdominal quadrant area [1, 9, 10]
Splenic Flexure Syndrome Diagnosis
There is no definitive diagnostic procedure that is used for splenic flexure syndrome yet. Though this is the case, there are still diagnostic steps which can be used to confirm the presence of the disease in the patient. 
1. Medical History
This will be obtained in order for the doctors to have a detailed assessment of the patient’s clinical data which can possibly help in ruling out the factors that may affect the gastrointestinal system. 
2. Dietary Review
- The doctor will also interview the patient to know more about his dietary habits. If there is a suspected digestive problem, the doctor may also ask how many times the patient passes gas within a day. This may indicate if there is an abnormality with the GI tract.
- 24 hour diet recall: A look into the patient’s 24 hour diet intake will enable the doctor to see if the patient’s diet is the culprit to the symptoms that are manifested.  and 
3. Physical Examination
This is done to assess the symptoms that may be related to the presence of the disease. Also, it is useful in identifying the cause. 
4. Gastrointestinal (GI) Series
This series of tests are done to rule out the underlying GI problems that are manifested by the patient. When there is no other diagnostic procedure of choice, this is the last resort to rule out the diagnosis. 
- Barium enema: Also known as lower GI examination, involves the use of X-ray of the large intestine (colon and rectum). This is done to help in the diagnosis of diseases affecting the large intestine. In this procedure, the contrast material, Barium, is inserted to the anus using a tube. This contrast material is what makes the intestine visible on the X-ray picture. 
Picture 2: Barium Enema Procedure
5. Imaging Studies
- Abdominal CT scan
- Abdominal MRI 
Splenic Flexure Syndrome Treatment
1. Diet Modification
- This is the first recommended treatment for most patients with this condition.
- Avoid eating gas-forming foods, including carbonated drinks
- Lessen intake of foods high in fat, starch, and sugar: to prevent bloating
- Restrict intake of highly irritating foods such as spicy foods
- The doctors usually advise the patient to increase fiber in the diet. This is to aid the digestive process.
- Also, it is recommended to have small frequent feedings instead of three large meals a day. 
2. Passing of stool/gas
This is another effective way to relieve the pain and discomfort experienced by the patient. 
3. Avoid air swallowing
- Most of the patients are advised to avoid air swallowing. This will greatly help in reducing gas production in the GI tract.
- In order to do this, doctors advise taking prebiotic supplements before eating.
- Also, the patients must be aware that the food must be chewed properly before swallowing it. 
4. Promote good posture
Maintaining good posture and avoiding hunching are great ways to prevent air trapping in the gastric system. 
- Antacids: taking these will aid in relieving bloating and discomfort. An example of this is Maalox. This is a common drug given to provide stomach discomfort relied. These agents work by helping in digesting foods and reducing the gas being produced.
- Antispasmodic drugs: These are given to reduce abdominal pain.
- Anticholinergic drugs: helps in relieving abdominal spasms. An example is Dicyclomine which aids in managing pain and fecal urgency.
- Metoclopramide: This promotes motility, relieves abdominal pain and discomfort.
- Beano: This is a medication which contains sugar-containing enzyme that aids in digestion. [1, 3, 8]
6. Surgical means
- Decompression: This involves the procedure called colonoscopy. This is done by inserting a rectal tube to decompress the colon and release the air trapped there. This would now treat the underlying cause of the condition.
Picture 3: Colonoscopy done for decompression
- If the condition is associated with obstruction, surgery may also be done to remove it. 
Splenic Flexure Syndrome Prognosis
The patients who undergo proper identification and treatment of underlying cause have a good prognosis. 
Points to Consider
In conditions such as splenic flexure syndrome, a visit to the doctor is necessary especially those who are bothered with the abdominal pain and discomfort. This is to immediately address the underlying condition which may be causing the symptoms. Though there are no definite ways to prevent this condition from occurring to someone, diet modification should be taken into consideration. This is because the gas-forming foods are the main culprit why this condition happens.
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