Gaseous colonic enlargement occurs in obstruction, intussusception and volvulus, and palpable abscess formation may occur with diverticulitis, inflammatory bowel disease and malignancy of the gut.
The colon may be palpable in most of its course, when loaded with solid or semi-solid fecal material, or if it is distended, as in intestinal obstruction. It is often smooth, ill defined and sausage shaped, with some side-to-side mobility. The contents may be indented. The cecum, in the right iliac fossa, is more rounded.
The transverse colon dips across the epigastrium and umbilical regions. The sigmoid colon passes across the left iliac fossa, descending into the pelvis. It is commonly felt in thin individuals and can be identified by its indentible fecal content. The ascending and descending portions of the colon can be felt in the right and left lumbar regions by direct palpation or bimanually. The gut is well visualized with barium studies and each end and stomas provide access for endoscopic examination (figure 43 a–d).