More papillary type of valve, strongly projecting far into the lumen and usually exhibiting radial folds on the valve opening (h). The prominence is sometimes caused by a pronounced accumulation of fat (lipomatous valve), recognizable by the intense yellow color (i).
► It is important that the cecum be thoroughly inspected, in order to avoid missing pathologies. The area of the cecum directly behind the Bauhin valve is especially difficult to examine in an inverted or mobile cecum. In some patients, the examiner can attempt to deflect the tip of the endoscope to the point of retroflexion, thereby allowing backward viewing of the ileocecal valve. However, this maneuver should be performed with the utmost caution because of risk of perforating the thin cecal wall. Overdistension of the cecum, which also increases risk of perforation, should likewise be avoided. This maneuver should only be performed by experienced examiners.
► It should be remembered that a raised polyplike form on the cecal pole might be an invaginated appendiceal stump from an earlier appendectomy (Fig. 6.33). This is an important consideration, as removal with a snare (if mistaken for an adenoma) can have adverse consequences, i. e., perforation.
► Identification of the ileal opening at the Bauhin valve can be made difficult by an overhanging valve lip or an inverted cecum. It is, however, extremely helpful for intubation of the terminal ileum to know beforehand where the valve orifice is located in relation to the valve. In addition, repeated attempts at intubation usually cause surface lesions and these can sometimes be difficult to correctly identify, e.g., they can be confused with angiectasias.
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