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 to the colon, and also makes its reverse cast impossible. The sphincter can be described as a tightening of muscles with a width of up to four centimeters, which forms a domed nipple.
As part of the norm, castings of what is in the colon into the ileum should not occur. Millions of microorganisms multiply plentifully in the ileocecal region, which are mainly representatives of the anaerobic flora, where their content reaches ninety percent. Loss of valve closure leads to excessive colonization of the small intestine with bacteria.
Both combined and isolated harmful functions of the ileocecal valve are likely, as well as the cecum, terminal section and appendix. We will figure out where the ileocecal angle is located and what its pathology affects.
Diseases characteristic of the ileocecal valve
The most famous ailment 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 x-ray studies in some cases, a stenosing tumor can be predicted. A histological examination reveals a massive infiltration of adipose tissue with the absence of a capsule characteristic of a lipoma.
Retrograde prolapse
Retrograde prolapse of the ileocecal valve is determined by invagination, or more simply, by the prolapse of tissue into the free region of the cecum, which creates a filling defect during an X-ray examination. The diagnosis in this case is usually clarified by colonoscopy. This takes into account the ileocecal angle, the anatomy of which is discussed in detail in our article.
Endometriosis
Endometriosis, which occurs in the ileocecal valve, usually occurs in conjunction with damage to the cecum and ileum. It also happens that cases of isolated lesions can be encountered in situations when tissue grows within the valve, which is identical in function and structure to the endometrium. The most common clinical symptoms are diarrhea, pain, and later complete intestinal obstruction. Against the background of a transmural lesion of the tissue walls, bleeding from the rectum during menstruation can occur. Often, a biopsy of the mucous membrane does not allow a diagnosis to be made with ileoscopy. It can be established only by laparoscopy using a biopsy of the intestinal serous membrane affected by endometriosis, or it may be possible with an operating biopsy. Foci of endometriotic tissue are detected microscopically. Often they are formed by glands of various sizes and sizes, and sometimes they are too extended and can be 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 damage to the ileocecal valve, which developed after the use of amoxicillin treatment, became known. Endoscopic, as well as clinical, signs of the disease disappeared immediately a few days after the antibiotic was withdrawn.
Description of diseases of the ileocecal angle of the body
The most common are inflammatory diseases, such as dysenteric ileotiflitis, yerseniosis and salmonella tuberculosis, as well as a disease still little known to science, called Crohn's disease or granulomatous ileocolitis. Cancer, actinomycosis and non-Hodgkin's lymphoma are equated with the most rare diseases in which the ileocecal angle of the colon suffers.
Nowadays, the population again quite often began to have tuberculosis, especially its extrapulmonary forms. During intestinal tuberculosis, the ileocecal region is primarily affected. In combination with the pain that occurs in the right iliac region, the majority of those suffering from the disease break their stools. At the first stage of the disease, constipation is often found, which turns into a debilitating and prolonged diarrhea, usually accompanied by blood.
If the ileocecal angle suffers, the lymph nodes are enlarged.
Difficulty in making a diagnosis
It is quite difficult to establish a diagnosis at the beginning of the disease. First, a differential diagnosis is made with cecum cancer, Crohn's disease, and ulcerative colitis. X-ray examination gives a chance to detect deformity of the cecum, ulcers, narrowing of the lumens and pseudo-polyps. The most informative way is laparoscopy, which often allows you to find tuberculous tubercles and calcified mesenteric lymph nodes. A competent diagnosis corresponds to the determination of increased sensitivity of patients to tuberculin, that is, a Mantoux test, as well as laparoscopy and computed tomography. How else is the ileocecal angle and vermiform appendix examined?
Diagnostic and research methods for this area
To examine the health status of patients using methods such as:
- X-ray examinations of the colon and small intestine;
- histological examination;
- colonoscopy;
- ileoscopy.
Colonoscopy ileoscopy has a number of undeniable advantages, because with their help it is possible to obtain biopsy material. The histological examination method is attributed a decisive role in the diagnosis of a large number of pathologies and defects of the ileocecal sphere. At the moment, as before, a significant place is occupied by the x-ray methodology for conducting studies of the ileocecal region. Although its application often manifests some difficulties that are associated with the fact that:
- Firstly, during retrograde contrast, the ileocecal valve is able to not open from time to time, and the distal area of the intestine remains practically inaccessible for research.
- Secondly, during the oral administration of barium suspension, the ileum is usually filled after about four hours, so contrasting the cecum is often unsatisfactory.
In addition, when taking barium suspension orally, it is quite difficult to determine the insufficiency of the bauginium damper. However, the described methods are quite effective in their application for diagnosing diseases of the terminal ileum.
Ultrasound scan
An equally important role in the diagnostic assessment of diseases associated with the ileocecal angle is played by the ultrasound examination technique. Thanks to the ultrasound, the standard characteristics regarding Crohn's disease are tracked quite accurately, as well as all sorts of pathologies associated with this ailment.
In 1997, foreign researchers proposed medicine for mesenteric artery dopplerography to establish inflammatory processes in the ileocecal region. For these purposes, duplex dopplerultrasonography was applied. The authors recorded that the amount, as well as the flow rate, of blood in the region of the superior mesenteric artery among the subjects with inflammatory processes and pathologies in the ileocecal region turned out to be much higher than among patients in the control group.
Laparoscopy
Of great importance in conducting diagnostic studies of ailments of the ileocecal region is laparoscopy. 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 diseases of the ileocecal region. Most of the currently existing scientific works 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 the functional diseases of the ileocecal angle, especially the dysfunction and pathology of the corresponding valve.
Conclusion
There are no works on differential diagnostic diseases of this intestine. In accordance with this, the subsequent study of any questions related to the study of diseases that occur with debilitating pains in the right iliac region causes a certain highly scientific interest for all clinics that carry out their activities for a detailed and thorough study of internal diseases.