Tag Archives: dolichocolon

Does Dolichocolon (Colonic Redundancy) Matter?

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  • D Simon et al. J Pediatr Gastroenterol Nutr. 2026;82:407–414. Dolichocolon is common in pediatric gastroenterology patients with constipation and associated complaints
  • L Dorfman, A Kaul. J Pediatr Gastroenterol Nutr. 2026;82:320–322 Commentary. Dolichocolon in pediatric patients with constipation—The chicken or the egg?

Methods: In this retrospective study, a total of 155 contrast enemas were administered and then assessed for features of colonic redundancy consistent with dolichocolon (DC), based on a priori imaging (adult) criteria.

“DC was defined as: any portion of the sigmoid colon reaching above the iliac crest line (Type 1), and/or any portion of the transverse colon reaching below the iliac crestline with or without redundant flexures (Type 2)…We decided not to study Type 3 DC (i.e., redundant loops at the hepatic or splenic flexure, example shown in Figure 1A*) separately because that category was deemed to be arbitrary/imprecise.”

Key findings:

  • Consensus‐based identification (i.e., independent agreement among all three reviewers) of dolichocolon (DC) was observed in 74.1% of children under 2 years old and 88.6% of those aged 2–4 years presenting with constipation
  • The prevalence subsequently significantly decreased with age, with 68.8% in children aged 5–10 years and 47.6% in adolescents aged 11–17 years. “The pattern of decreasing prevalence of DC with age after 5 years is in contrast to findings in adult patients over 40 years with constipation, where DC frequency was found to increase significantly with age”
  • The vast majority (95.6%) of DC was Type 1; 3.5% was Type 2. 0.9% was both Type 1 and Type 2
The dashed line marks the iliac crest line [IC]; the gray arrow
highlights the sigmoid colon reaching above the IC
The blue arrow highlights the transverse colon falling below the IC

The editorial by Dorfman et al. notes that “dolichocolon has a long history in medical literature, but its exact role remains uncertain, presenting a classic “chicken or the egg” dilemma…Until more stringent pediatric-specific definitions and longitudinal evidence are acquired, clinicians should exercise caution in solely attributing symptoms to dolichocolon…While dolichocolon may play a role, it is unlikely to be the sole cause.” 

My take: I had to read the article because I was not familiar with the term “dolichocolon.” The authors, though, summarize the key point: “the clinical relevance of this radiologic finding is not completely understood.” As a separate matter, a pediatric study on how a dolichocolon affects colonoscopy would be interesting; presumably, it would make it more difficult with longer duration and lower rates of TI intubation.

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