The ileocecal angle is the site of a very large number of diseases, which is directly related to the anatomical and physiological structure of this intestine. The ileocecal sphincter controls the movement of contents from the small intestine into the large intestine, and also makes it impossible to return it. The sphincter can be described as a thickening of muscles up to four centimeters wide that forms a domed nipple.
Within the framework of the norm, there should not be a reflux of what is in the large intestine into the ileum. In the ileocecal region, millions of microorganisms multiply abundantly, which are mainly representatives of the anaerobic flora, where their content reaches ninety percent. Loss of the closing ability of the valve leads to excessive contamination of the small intestine with bacteria.
Both combined and isolated harmful functions of the ileocecal valve are likely, and in addition, also the caecum, terminal section and appendix. Find out where it's locatedileocecal angle and what its pathology affects.
Ileocecal valve diseases
The most famous disease is lipomatosis. In the process of a significant increase in the volume of fat in the region of the submucosal layer, the valve walls become denser, and its lumen narrows. When conducting an x-ray examination, in some cases, a stenosing tumor can be predicted. Histological examination reveals a massive infiltration of fatty tissues with the absence of a capsule characteristic of a lipoma.
Retrograde prolapse
Retrograde ileocecal valve prolapse is determined by intussusception, or, more simply, by prolapse of tissue into the free area of the caecum, which creates a filling defect during X-ray examination. The diagnosis in this case is usually specified during colonoscopy. This takes into account the ileocecal angle, the anatomy of which is discussed in detail in our article.
Endometriosis
Endometriosis occurring in the ileocecal valve usually occurs in conjunction with lesions of the caecum and ileum. It also happens that one can meet cases of isolated lesions in such situations when tissue grows within the valve, identical in function and structure to the endometrium. The most common clinical symptoms are diarrhea, pain, and later complete intestinal obstruction occurs. Against the background of transmural lesions of the tissue walls, bleeding from the rectum during menstruation can occur. Often, mucosal biopsyshell does not allow to establish the diagnosis during ileoscopy. It can be established only with laparoscopy using a biopsy of the serous membrane of the intestine affected by endometriosis, or it may be possible with an operational biopsy. Foci of endometriosis tissue are detected microscopically. Often they are formed by glands of various sizes and sizes, and sometimes they are too dilated and capable of being surrounded by a cytogenic stroma. Cysts and glands are literally dotted with a uniform cylindrical epithelium, which can be attributed to the endometrial type. What else is the ileocecal angle of the intestine famous for?
In 1994, a case of pseudotumor hemorrhagic injury of the ileocecal valve became known, which developed after the use of amoxicillin treatment. Endoscopic, as well as clinical, signs of the disease disappeared immediately a few days after the antibiotic was discontinued.
Description of diseases of the ileocecal angle of the body
Inflammatory diseases are considered the most common, such as dysenteric ileotiflitis, yersenia and salmonella tuberculosis, as well as a little-known disease called Crohn's disease or granulomatous ileocolitis. The most rare diseases in which the ileocecal angle of the colon suffers are cancer, actinomycosis and non-Hodgkin's lymphoma.
Tuberculosis, especially its extrapulmonary forms, has again become quite common among the population today. During intestinal tuberculosis, the ileocecal region suffers primarily. In combination with pain that occurs in the right iliac region, the stool is disturbed in most people suffering from the disease. In the first stage of the disease, constipation is common, which progresses to debilitating and prolonged diarrhea, usually accompanied by blood.
If the ileocecal angle suffers, the lymph nodes are enlarged.
Difficulty in making a diagnosis
Establish a diagnosis at the beginning of the disease is difficult enough. First, a differential diagnosis is made with cancer of the caecum, Crohn's disease, and ulcerative colitis. X-ray examination gives a chance to detect deformity of the caecum, ulcers, narrowing of the lumen and pseudopolyps. The most informative method is laparoscopy, which allows more often to find tuberculous tubercles and calcified mesenteric lymph nodes. Competent diagnostics corresponds to the determination of the hypersensitivity of patients to tuberculin, that is, the Mantoux test, as well as laparoscopy and computed tomography. How else is the ileocecal angle and appendix examined?
Methods of diagnostics and research of the specified area
To examine the he alth status of patients, methods such as:
- X-ray examination of the colon and small intestine;
- histological examination;
- colonoscopy;
- ileoscopy.
Ileoscopy with colonoscopy has a number of undeniable advantages, because with their help it is possible to getbiopsy material. The histological method of examination is credited with a decisive role in the diagnosis of a large number of pathologies and defects of the ileocecal sphere. At the moment, as before, an important place is occupied by the X-ray technique for conducting research of the ileocecal region. Although its application often shows some difficulties that are associated with the fact that:
- Firstly, during retrograde opacification, the ileocecal valve may not open from time to time, while the distal region of the intestine remains practically inaccessible for examination.
- Second, during the period of oral barium suspension, the ileum usually fills up after about four hours, so the contrast of the caecum is often unsatisfactory.
Plus, with oral administration of barium suspension, it is quite difficult to determine the insufficiency of the Bauhinia valve. However, the described methods are quite effective when used to diagnose diseases of the terminal region of the ileum.
Ultrasound
An equally important role in the diagnostic evaluation of diseases associated with the ileocecal angle is played by the ultrasound examination technique. Thanks to ultrasound, standard characteristics regarding Crohn's disease, as well as all sorts of pathologies associated with this disease, are tracked quite accurately.
In 1997, foreign researchers offered medicine dopplerography of the mesenteric artery forestablishment of inflammatory processes in the ileocecal region. For this purpose, duplex Doppler ultrasonography was used. The authors recorded that the amount, as well as the flow rate, of blood in the region of the superior mesenteric artery among subjects with inflammatory processes and pathologies in the ileocecal region turned out to be much higher than among patients in the control group.
Laparoscopy
Laparoscopy is of great importance in carrying out diagnostic studies of ailments of the ileocecal region. In particular, its role becomes especially noticeable against the background of recognition of intestinal or, one might say, extragenital endometriosis, in addition, Crohn's disease, eosinophilic ileitis, tuberculosis and mesenteric lymph nodes, as well as actinomycosis and chronic appendicitis.
Other diseases in this area
Thus, a detailed and thorough study of the literature of recent years has revealed the existence of several dozen more diseases of the ileocecal region. Most of the currently existing scientific papers are devoted to inflammatory processes, namely terminal ileitis, as well as acute chronic appendicitis and Crohn's disease. Unfortunately, there is still not enough information about functional diseases of the ileocecal angle, in particular dysfunction and pathology of the corresponding valve.
Conclusion
There are no works on differential diagnostic diseases of this part of the intestine. Accordingly, the followingthe study of any issues related to the study of diseases that go away with debilitating pain in the right iliac region causes a certain highly scientific interest for all clinics that carry out their activities in a detailed and thorough study of internal diseases.
