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Endgames Spot Diagnosis

Abdominal pain in a 24 year old woman

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i5264 (Published 13 October 2016) Cite this as: BMJ 2016;355:i5264

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Re: Abdominal pain in a 24 year old woman

Confusion in terminology of the colon.
The authors draw attention to ‘oedema of the haustral folds’ in the case presentation on ‘Abdominal pain in a 24 year old’. (SPOT DIAGNOSIS), implying that the infolded colonic wall is the haustrum. Haustrum is derived from the Latin word which means a bucket or scoop and the term applied to the colon due to the resemblance of the sacculations to the buckets on a water wheel. It is not entirely clear whether the saccules and the infolding of the wall is due to the taenia coli being shorter than the overall length of the colon or whether the circular muscle indentations also contribute to it.
Therefore the term haustrum (pleural haustra) should be restricted to the sacculations and the infolded wall of the colon between the sacculations or the haustra should be referred to as the interhaustral fold. Based on the derivation of the word haustrum the folds cannot be the haustra. The colon would therefore have a central lumen with which the haustral lumen communicates by a wide opening.
The recognition of this nomenclature is significant since when the there is marked dilatation of the colon with disappearance of the interhaustral folds there has been reference to the erosion and hence lack of the so called ‘haustra’. If erosion of the folds is the reason for their disappearance this would result in numerous perforations of the colonic wall.
The interhaustral folds are not uncommonly referred to as the haustra even by gastroenterologists and even in some text books especially the older textbooks.

Competing interests: No competing interests

20 October 2016
Anton Joseph
Emeritus Consultant Radiologist
none
Croydon University Hospital
76 Park Hill Road