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Right colic flexure (hepatic flexure)

The right colic flexure, also known as the hepatic flexure, is the sharp bend of the colon located between the ascending colon and the transverse colon. It lies in the right upper quadrant of the abdomen, directly inferior to the liver. This flexure is less acute than the splenic flexure and is more mobile, reflecting its anatomical relations with the liver, gallbladder, duodenum, and right kidney.

Synonyms

  • Hepatic flexure

  • Right colic flexure

  • Right upper colonic bend

Location and Relations

  • Anteriorly: Inferior surface of the liver and gallbladder

  • Posteriorly: Right kidney

  • Medially: Second part of the duodenum

  • Superiorly: Inferior margin of liver

  • Inferiorly: Loops of jejunum and ileum

Function

  • Forms the junction between ascending colon and transverse colon

  • Facilitates mixing and propulsion of fecal contents

  • Plays a role in water and electrolyte absorption

Clinical Significance

  • Common site for colonic tumors, obstruction, volvulus

  • May be compressed or displaced by hepatomegaly, gallbladder or right kidney pathology

  • Important in colon cancer staging and virtual colonoscopy

  • Surgical landmark during right hemicolectomy

MRI Appearance

T1-weighted GRE (Gradient Echo):

  • Colonic wall: thin low signal

  • Lumen air: signal void (black)

  • Lumen fat (stool with fat): bright signal

  • Tumor or wall thickening: focal low-to-intermediate signal lesion

T2-weighted HASTE (Half-Fourier Single-shot Turbo Spin Echo):

  • Colonic lumen fluid: bright hyperintense

  • Lumen air: dark signal void (black)

  • Normal colonic wall: thin dark line

  • Pathologic wall (tumor, colitis, edema): intermediate-to-bright signal

CT Appearance

Non-Contrast CT:

  • Colonic wall: soft tissue density, normally thin

  • Lumen air: very low attenuation (black)

  • Lumen fluid: low attenuation (10–20 HU)

  • Fecal material: mixed density with mottled air bubbles

  • Pathology: wall thickening, masses, fat stranding, calcifications (rare)

Post-Contrast CT:

  • Normal wall: mild homogeneous enhancement

  • Inflammation: symmetric wall thickening, mucosal hyperenhancement

  • Tumors: focal irregular enhancing mass, shouldered edges

  • Abscess/perforation: extraluminal air, rim-enhancing fluid

CT Colonoscopy (Virtual Colonoscopy):

  • Flexure: acute bend between ascending and transverse colon

  • Lumen air: black, well-distended lumen provides negative contrast

  • Normal wall: thin, smooth contour

  • Tumors/polyps: intraluminal soft tissue protrusions into air-filled lumen

  • Obstruction: failure of air to distend beyond lesion

CT image

Right colic flexure (hepatic flexure) ct coronal anatomy image-img-00000-00000

CT image

Right colic flexure (hepatic flexure) ct sagittal anatomy image-img-00000-00000

MRI image

Right colic flexure (hepatic flexure) mri sagittal anatomy image-img-00000-00000

MRI image

Right colic flexure (hepatic flexure) MRI coronal anatomy image-img-00000-00000