Difference between revisions of "Ileocecal valve"

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Ileocecal valve (view source)

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The '''ileocecal valve''' is the divider between the [[small bowel]] and cecum.  It is seen by pathologist in some subtotal colectomies (e.g. right hemicoloectomies) and occasionally biopsied.
[[Image:Gray1075.png|thumb|200px|Drawing of the ileocecal valve (Gray's anatomy).]]
The '''ileocecal valve''', abbreviated '''IC valve''', is the divider between the [[small bowel]] and cecum.  It is seen by pathologist in some subtotal colectomies (e.g. right hemicoloectomies) and occasionally biopsied.
 
==Lipomatous ileocecal valve==
*[[AKA]] ''lipomatosis of the ileocecal valve''
===General===
*The lesion should involve the valve circumferentially.
**True lipomas of the ileocecal have a capsule, are not circumferential and less common.<ref name=pmid6212382>{{Cite journal  | last1 = Skaane | first1 = P. | last2 = Eide | first2 = TJ. | last3 = Westgaard | first3 = T. | last4 = Gauperaa | first4 = T. | title = Lipomatosis and true lipomas of the ileocecal valve. | journal = Rofo | volume = 135 | issue = 6 | pages = 663-8 | month = Dec | year = 1981 | doi = 10.1055/s-2008-1056492 | PMID = 6212382 }}</ref>
 
Clinical:
*May be misdiagnosed as malignancy.<ref name=pmid17676259>{{Cite journal  | last1 = Petrović | first1 = J. | last2 = Barisić | first2 = G. | last3 = Saranović | first3 = D. | last4 = Micev | first4 = M. | last5 = Krivokapić | first5 = Z. | title = Lipomatosis of the ileocecal valve treated with right hemicolectomy as the consequence of an incomplete diagnostic procedure. | journal = Tech Coloproctol | volume = 11 | issue = 3 | pages = 278-80 | month = Sep | year = 2007 | doi = 10.1007/s10151-007-0366-6 | PMID = 17676259 }}</ref>
*Reported to mimic [[Crohn's disease]].<ref name=pmid1437927>{{Cite journal  | last1 = Bhupalan | first1 = AJ. | last2 = Forbes | first2 = A. | last3 = Lloyd-Davies | first3 = E. | last4 = Wignall | first4 = B. | last5 = Murray-Lyon | first5 = IM. | title = Lipomatosis of the ileocaecal valve simulating Crohn's disease. | journal = Postgrad Med J | volume = 68 | issue = 800 | pages = 455-6 | month = Jun | year = 1992 | doi =  | PMID = 1437927 }}</ref>
 
===Gross===
*"Ileocecal valve prominent".
 
===Microscopic===
Feature:
*Mature adipocytes.
*No capsule.<ref name=pmid6212382/>
 
DDx:
*[[Lipoma]] of the ileocecal valve - have a capsule.
 
Image:
*[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3015905/figure/F3/ Lipoma of the IC valve (nih.gov)].<ref name=pmid19366548>{{Cite journal  | last1 = Dultz | first1 = LA. | last2 = Ullery | first2 = BW. | last3 = Sun | first3 = HH. | last4 = Huston | first4 = TL. | last5 = Eachempati | first5 = SR. | last6 = Barie | first6 = PS. | last7 = Shou | first7 = J. | title = Ileocecal valve lipoma with refractory hemorrhage. | journal = JSLS | volume = 13 | issue = 1 | pages = 80-3 | month =  | year =  | doi =  | PMID = 19366548 | PMC = 3015905}}</ref>
 
===Sign out===
<pre>
ILEOCECAL VALVE, BIOPSY:
- SUBMUCOSA WITH A LARGE CLUSTER OF MATURE ADIPOCYTES, SEE COMMENT.
- BOWEL MUCOSA WITHIN NORMAL LIMITS.
 
COMMENT:
The findings are consistent with a lipomatous ileocecal valve.
</pre>
 
====Small amount of adipose tissue====
<pre>
ILEOCECAL VALVE ("PROMINENT"), BIOPSY:
- COLONIC-TYPE MUCOSA WITH PROMINENT PANETH CELLS AND FOCAL LAMIMA
  PROPRIA NEUTROPHILS.
- SMALL AMOUNT OF BENIGN (SUBMUCOSAL) ADIPOSE TISSUE.
- NO DEFINITE ACUTE VALVITIS.
- NEGATIVE FOR DYSPLASIA.
</pre>
 
====No submucosa====
<pre>
ILEOCECAL VALVE, BIOPSY:
- COLONIC-TYPE MUCOSA WITHIN NORMAL LIMITS.
- NO SUBMUCOSA PRESENT.
</pre>
 
==Ileocecal tuberculosis==
===General===
*Ileocecal region and jejunoileal region are the most commonly affected areas in gastrointestinal tuberculosis.<ref>{{Ref GLP|282}}</ref><ref name=pmid3922847>{{Cite journal  | last1 = Bhargava | first1 = DK. | last2 = Tandon | first2 = HD. | last3 = Chawla | first3 = TC. | last4 = Shriniwas | first4 = BN. | last5 = Tandon | first5 = BM. | last6 = Kapur | first6 = . | title = Diagnosis of ileocecal and colonic tuberculosis by colonoscopy. | journal = Gastrointest Endosc | volume = 31 | issue = 2 | pages = 68-70 | month = Apr | year = 1985 | doi =  | PMID = 3922847 }}</ref><ref>{{Cite journal  | last1 = Engin | first1 = G. | last2 = Balk | first2 = E. | title = Imaging findings of intestinal tuberculosis. | journal = J Comput Assist Tomogr | volume = 29 | issue = 1 | pages = 37-41 | month =  | year =  | doi =  | PMID = 15665681 }}</ref>
 
===Microscopic===
:''See [[Tuberculosis]]''.
 
==Ileocecal valve ulceration==
===General===
*Relatively uncommon.
 
===Microscopic===
Features:
*Fibrin - acellular amorphous eosinophilic material.
*[[Neutrophil]]s.
*[[Cryptitis]] (focal).
 
DDx:
*[[Crohn's disease]].
*[[NSAID]]-associated ulcer.<ref name=pmid18756986>{{Cite journal  | last1 = Liu | first1 = JX. | last2 = Wang | first2 = HH. | title = [Clinical and pathological features of benign ileocecal ulcerative lesions discovered by ileocolonoscopy: analysis of 31 cases]. | journal = Zhonghua Yi Xue Za Zhi | volume = 88 | issue = 12 | pages = 823-5 | month = Mar | year = 2008 | doi =  | PMID = 18756986 }}</ref>
*Infection, e.g. [[tuberculosis]].
*Idiopathic - common for small lesions.<ref name=pmid18756986/>
*Mechanical forces (shear) - in a prominent IC valve.
**Shearing forces are certainly present<ref name=pmid19249356>{{Cite journal  | last1 = Gayer | first1 = CP. | last2 = Basson | first2 = MD. | title = The effects of mechanical forces on intestinal physiology and pathology. | journal = Cell Signal | volume = 21 | issue = 8 | pages = 1237-44 | month = Aug | year = 2009 | doi = 10.1016/j.cellsig.2009.02.011 | PMID = 19249356 }}</ref>... not studied.
===Sign out===
====Early changes due to mechanical factors in a prominent valve====
<pre>
ILEOCECAL VALVE, BIOPSY:
- SMALL BOWEL MUCOSA WITH FOCAL CRYPTITIS, SEE COMMENT.
-- NEGATIVE FOR GRANULOMAS AND NEGATIVE FOR ARCHITECTURAL DISTORTION.
-- NEGATIVE FOR DYSPLASIA.
 
COMMENT:
The clinical history is noted. No adipose tissue is seen in this superficial mucosal
biopsy. The cryptitis is seen focally at the tips of well-formed villi. This could be due
to mechanical factors; however, other causes should be considered clinically.
</pre>
 
<pre>
ILEOCEAL VALVE, BIOPSY:
- BOWEL MUCOSA WITH MILD ACTIVE INFLAMMATION, SEE COMMENT.
-- NEGATIVE FOR GRANULOMAS.
-- NEGATIVE FOR DYSPLASIA.
 
COMMENT:
The clinical history (prominent ileocecal valve) is noted. No adipose tissue is seen in
this superficial mucosal biopsy.
 
The inflammation is focal and superficial, and blunted-appearing villi are present. The
changes may be due to mechanical factors; however, other causes should be considered
clinically.
 
</pre>


==See also==
==See also==
*[[Small bowel]].
*[[Small bowel]].
*[[Colon]].
*[[Colon]].
==References==
{{Reflist|2}}


[[Category:Gastrointestinal pathology]]
[[Category:Gastrointestinal pathology]]
Michael
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