Normal Ascending Colon

The ascending colon runs near the right flank between the hepatic flexure and the ileocecal valve. Similar to the descending colon, the ascending colon is fixed to the dorsal abdominal wall and thus only slightly mobile, running relatively straight. The length of the ascending colon is variable, on average around 15-20 cm. However, it is occasionally very short, so that immediately after passing the hepatic flexure the ileocecal valve is reached. At the other extreme is a very long ascending colon, with the Bauhin valve located deep in the lower abdomen.

Sigmoid Colon

As a rule, the ascending colon has the widest lumen of any of the colon segments. The lumen is mostly triangular, similar to the transverse colon (Fig. 6.23), though the folds are mostly somewhat thicker and plumper than the more distal colon segments (Fig. 6.24). After passing the hepatic flexure, one often can already see the ileocecal valve in the distance as a yellowish arcuate fold, often with an indentation in the center (Fig. 6.25). Occasionally the valve is clearly prominent due to an accumulation of fat (Fig. 6.26). The mucosal appearance and vessel pattern in the ascending colon are the same as in the rest of the colon proximal to the rectum (Figs. 6.27, 6.28).

Tips for examining the ascending colon

► Due to the relatively thin colonic wall in the ascending colon and cecum, care must be taken to avoid perforation during therapeutic procedures such as argon plasma coagulation, laser therapy, and polyp removal. Precautionary measures for avoiding perforation, including liberally injecting flat polyps before removal with a snare, are strongly advised.

Ileocecal Valve Removal

Fig. 6.24 Ascending colon and ileocecal valve (yellowish, thickened fold shown here at about the 12-o'clock postion), the cecal pole can be seen in the distance. Note the relatively wide lumen in the ascending colon. The folds are somewhat thicker compared to the transverse colon.

Fig. 6.24 Ascending colon and ileocecal valve (yellowish, thickened fold shown here at about the 12-o'clock postion), the cecal pole can be seen in the distance. Note the relatively wide lumen in the ascending colon. The folds are somewhat thicker compared to the transverse colon.

Fig. 6.25 Normal ascending colon with typical aspect of the ileocecal valve (shown here at about the 6-o'clock postion) as a yellowish fold with an indentation in the center.

Fig. 6.26 Ascending colon with lipomatous, thickened, ileocecal valve, with clearly visible opening, protruding far into the lumen. A secondary finding is the small, light red an-giectasis on the valve.

Normal Colon Mucosa
Fig. 6.27 Ascending colon. Normal shiny mucosa with very distinct vascular pattern directly over the Bauhin valve, which is partially covered by a fold from the ascending colon.

Fig. 6.28 Normal ascending colon with the Bauhin valve, which appears relatively pale here (at about the 12-o'clock position). The view of the cecum is obscured by the ileoce-cal valve protruding into the lumen.

Fig. 6.29 Cecal pole with entrance to appendix. The star-shaped form of the three tenia converging at the appendiceal orifice (at about the 2-o'clock, 7-o'clock, and 11-o'clock positions).

Constipation Prescription

Constipation Prescription

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Responses

  • leon
    How wide is the lumen of the sigmoid colon?
    7 years ago
  • iva
    How wide is a normal cecum?
    4 years ago

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