Normal ileocecal junction

Case contributed by Dr Matt A. Morgan

Patient Data

Age: 61Y
Gender: Female
Fluoroscopy

A normal, competent ileocecal valve/sphincter is outlined in a single contrast barium enema.

CT

CT study of the same patient

The ileocecal junction in the same patient.

Annotated image

Annotated images:

  • open red arrows: point to the fatty attenuation of the ileocecal valve/sphincter
  • orange curve: outlines the terminal ileum as it enters the colon at the ileocecal junction
  • open green arrow: tip of the appendix.
CT

Patient #2

Different patient: The fatty "lips" of the ileocecal valve.

Case Discussion

The ileocecal junction marks the transition from the small bowel to the large bowel.

Although the portal has traditionally been termed the "ileocecal valve", anatomic studies suggest that it is more of a sphincter than a valve (in the mechanical sense of the mitral "valve") 1,2,3.

Any pathologic process that affects the cecum or the paracaecal area (e.g. the paracaecal mesenteries) may disrupt the sphincter. Carcinoma can arise off the valve, infections of the ileocecal junction (e.g. tuberculosis) can affects its function, and inflammatory bowel disease (e.g. ulcerative colitis) can stricture the valve, leading to backwash ileitis from the colon. A carcinoid tumor in the right lower quadrant mesenteries could tether the ileocecal junction and disrupt the sphincter's function.

The fat attenuation at the ileocecal junction also serves as a landmark for finding the appendix... the appendix is always below it.

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Case information

rID: 33824
Published: 27th Jan 2015
Last edited: 14th Aug 2019
Inclusion in quiz mode: Excluded

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