Normal Cecum and Ileocecal Valve

Cecum Pole
Cecum. The short segment of the colon between the appendix and the ileocecal valve is the cecum.
Cecum Tenia
Fig. 6.30 Cecal pole. One of the tenia leading to the appendiceal orifice (from about the 9-o'clock position). Note the distinct vascular pattern of the normal mucosa.

The cecum is only a few centimeters long. At its blind end, the three taenia coli converge in a star-shaped formation (Figs. 6.29, 6.30). This is where the entrance to the appendix is located, which normally can be recognized as a dotlike round or oval opening similar to a diverticulum (Figs. 6.31,6.32). If the appendix has been removed, a raised polyplike form, the invagination of the appendiceal stump, will often be seen (Fig. 6.33). Like the ascending colon, the posterior side of the cecum can be retroperitoneally fixed, though it also can be completely intraperitoneal, and is then often located across from the axis of the ascending colon or inverted. This can make visualization into the cecum and advancement to the cecal pole difficult. The diameter of the cecum, like that of the ascending colon, is wider than in the other colon segments. The wall of the cecum is very thin, only a few millimeters thick.

Ileocecal valve. The ileocecal valve is the anatomical demarcation between the cecum and the ascending colon and is the point where the ileum meets the colon. The ileum enters into the wall of the colon from the side, with the sphincterlike ileoce-cal valve at its end, preventing backward flow of the contents of the colon into the ileum.

The ileocecal valve can have very different endoscopic appearances (06.2). It can be merely a yellowish protruding fold in the lumen (especially when the opening is toward the cecum). Or, like a papilla, it can be arcuate, protruding far into the lumen with a readily visible ileal opening. Occasionally, there is evidence of a pronounced accumulation of fat in the ileocecal valve, also known as a lipo-matous valve. The valve is then an intense yellow, usually prominent and raised like a polyp. Identifying the ileocecal valve is the surest endoscopic landmark, indicating that the cecum has been reached.

Normal Cecum and Ileocecal Valve

What Cecum

Fig. 6.31 Close-up of appendiceal orifice, round configuration shown here. Again two of three converging tenia are visible.

Fig. 6.31 Close-up of appendiceal orifice, round configuration shown here. Again two of three converging tenia are visible.

Fig. 6.32 Close-up of appendiceal orifice, oval configuration shown here. The very lightly spotted appearance around the orifice is caused by a small lymph follicle, often found here.

Fig. 6.33 Invaginated appendiceal stump from previous appendectomy. The wormlike appearance and smooth surface are typical, helping distinguish it from an adenoma. If there is any uncertainty, take only an ex-cisional biopsy; resection of the appendiceal stump using a snare involves a high risk of perforation.

|T| Various endoscopic appearances of the ileocecal valve -

Ileocecal Valve

-c Valve with the ileal opening pointing toward the cecum, usually appearing as a thickened, yellowish fold, protruding into the lumen. A more or less pronounced indentation is often visible at the orifice (b, c). Intubation of this type of overhanging valve is often difficult, due to lacking visualization.

Sigmoid Colon Constipation Oval Orifice

d-f Labial form of the valve with a clearly oval-shaped orifice. The lips are sometimes slightly open (f). Intubation of this type of valve is usually unproblematic.

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Responses

  • corrado
    What a normal ileocecal and cecum?
    8 years ago
  • Eden
    Where Ileum meets colon?
    7 years ago
  • Cheryl
    What is ileocecal images of it open and closed?
    7 years ago
  • John
    What is the difference between appendiceal orifice and iliocecal valve?
    7 months ago
  • clara
    Which one come first, cecum or ileocecal valve?
    7 months ago
  • eglantine
    What is lymphoid follicle formation in ileocecal valve?
    13 days ago

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