Ileocecal valve: Difference between revisions

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[[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.

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*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===

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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==

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*Fibrin - acellular amorphous eosinophilic material.

*[[Neutrophil]]s.

*Cryptitis (focal).

*[[Cryptitis]] (focal).

DDx:

*[[Crohn's disease]].

*[[NSAID]]-associated ulcer.<ref>{{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>

*[[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==

@@ Line 1: / Line 1: @@
+[[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.
@@ Line 10: / Line 11: @@
 *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===
@@ Line 18: / Line 22: @@
 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==
@@ Line 34: / Line 68: @@
 *Fibrin - acellular amorphous eosinophilic material.
 *[[Neutrophil]]s.
-*Cryptitis (focal).
+*[[Cryptitis]] (focal).
 DDx:
 *[[Crohn's disease]].
-*[[NSAID]]-associated ulcer.<ref>{{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>
+*[[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==

Ileocecal valve: Difference between revisions

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