Underwater cap-suction pseudopolyp formation for endoscopic mucosal resection: a simple technique for treating flat, appendiceal orifice or ileocecal valve colorectal lesions

BACKGROUND

We aimed to evaluate the safety and technical success of an easy-to-use technique that applies underwater cap suction pseudopolyp formation to facilitate the resection of flat lesions or those at the appendiceal orifice or ileocecal valve.

METHODS

We retrospectively analyzed a register of consecutive cap suction underwater endoscopic mucosal resection (CAP-UEMR) procedures performed at two centers between September 2020 and December 2021. Procedures were performed using a cone-shaped cap, extending 7 mm from the endoscope tip, to suction the lesion while submerged underwater, followed by underwater snare resection. Our primary end point was technical success, defined as macroscopic complete resection.

RESULTS

We treated 83 lesions (median size 20 mm; interquartile range [IQR] 15-30 mm) with CAP-UEMR: 64 depressed or flat lesions (18 previously manipulated, 9 with difficult access), 11 from the appendix, and 8 from the ileocecal valve. Technical success was 100 %. There were seven intraprocedural bleedings and two delayed bleedings, all managed endoscopically. No perforations or other complications occurred. Among the 64 lesions with follow-up colonoscopy, only one recurrence was detected, which was treated endoscopically.

CONCLUSIONS

CAP-UEMR was a safe and effective technique for removing nonpolypoid colorectal lesions, including those arising from the appendiceal orifice or ileocecal valve.

Minimally invasive colonoscopy treatment of inflammatory fibroid polyps in the terminal ileum

To identify the characteristics of inflammatory fibroid polyps (IFP) in the terminal ileum and to investigate the methods, safety, and efficacy of colonoscopic minimally invasive dissection and resection therapies for its treatment. Colonoscopy and colonoscopic ultrasonography were used to diagnose patients with protruding mucosal lesions in the terminal ileum, and the results suggested a high suspicion of IFPs. Colonoscopic minimally invasive dissection and resection were performed for these patients, and IFP was confirmed by postoperative pathological examination and immunohistochemical staining. Twelve cases of IFP from April 2016 to December 2020 in our hospital were examined pathologically and immunohistochemically. The IFPs in the terminal ileum were all successfully excised by colonoscopy. There were no postoperative perforation, bleeding, or recurrence cases during the follow-up. The features of the lesions, as well as the efficacy of colonoscopic minimally invasive dissection and resection, were reviewed. Terminal ileum IFPs have corresponding colonoscopic and endoscopic ultrasonographic features. For IFPs less than 2 cm in size and within 10 cm of the ileocecal valve, removal by colonoscopy was proven less invasive, safe, and effective.

Characteristics and Endoscopic Classification of Ulcerative Lesions Affecting the Ileocecal Valve

OBJECTIVES

The aim of this study was to propose an endoscopic classification system for ulcerative lesions on the ileocecal valve and investigate its relevance to the underlying etiology.

METHODS

Among the 60,325 patients who underwent colonoscopy at our hospital from January 2006 to December 2018, patients with ulcerative lesions on the ileocecal valve were included. The following data were obtained using the hospital's medical records: sex, age, clinical diagnosis, laboratory data, and endoscopic and histological findings. Patients who have ulcerative colitis and who were not evaluated by histological examination were excluded. Ulcerative lesions on the ileocecal valve were classified into 3 groups according to their endoscopic appearance: small shallow ulcerative lesions without edematous change (group A), lateral spreading shallow ulcerative lesions with edematous change (group B), and deep deformed ulcerative lesions (group C). The association between this endoscopic classification and its clinical diagnosis, clinical course, and the interobserver reliability were evaluated.

RESULTS

Of 72 patients who were eligible for analysis, 18 were assigned to group A, 9 to group B, and 45 to group C. Infectious enteritis was mainly assigned to group A (group A, 12; group B, none; and group C, 6; p < 0.0001), inflammatory bowel disease was mainly assigned to group C (group A, none; group B, 5; and group C, 35; p < 0.0001), and malignant tumor was assigned to group C only. Interobserver reliability was extremely high among the 3 examining doctors (kappa value 0.7-0.8).

CONCLUSION

Endoscopic classification was divided into 3 groups for ulcerative lesions on the ileocecal valve, and this system could be beneficial for presuming their clinical diagnoses.

[Mucinous cystadenoma of the ileocecal valve. Uncommon intestinal tumor in a oneyear-old boy. Case report]

Mucinous cystadenoma is usually found in the ovary, pancreas and appendix but its presentation in the intestine is extremely rare. In this case report we present an infant with partial intestinal occlusion due to a mucinous cystadenoma of the ileocecal valve. We performed an excision of the terminal ileum, ileocecal valve, cecum and appendix, followed by ileocolic anastomosis. The patient did well after the procedure and recovered uneventfully. To our knowledge, this is the first case report of this tumor in this location.

Systematic review of epidemiology, presentation, and management of Meckel's diverticulum in the 21st century

BACKGROUND

The contemporary demographics and prevalence of Meckel's diverticulum, clinical presentation and management is not well described. Thus, this article aims to review the recent literature concerning Meckel's diverticulum.

METHODS

A systematic PubMed/Medline database search using the terms "Meckel" and "Meckel's" combined with "diverticulum." English language articles published from January 1, 2000 to July 31, 2017 were considered. Studies reporting on the epidemiology of Meckel's diverticulum were included.

RESULTS

Of 857 articles meeting the initial search criteria, 92 articles were selected. Only 4 studies were prospective. The prevalence is reported between 0.3% and 2.9% in the general population. Meckels' diverticulum is located 7 to 200 cm proximal to the ileocecal valve (mean 52.4 cm), it is 0.4 to 11.0 cm long (mean 3.05 cm), 0.3 to 7.0 cm in diameter (mean 1.58 cm), and presents with symptoms in 4% to 9% of patients. The male-to-female (M:F 1.5-4:1) gender distribution is reported up to 4 times more frequent in men. Symptomatic patients are usually young. Of the pediatric symptomatic patients, 46.7% have obstruction, 25.3% have hemorrhage, and 19.5% have inflammation as presenting symptom. Corresponding values for adults are 35.6%, 27.3%, and 29.4%. Ectopic gastric tissue is present in 24.2% to 71.0% of symptomatic Meckel's diverticulum, is associated with hemorrhage and is the most common form of ectopic tissue, followed by ectopic pancreatic tissue present in 0% to 12.0%.

CONCLUSION

The epidemiological patterns and clinical presentation appears stable in the 21st century. A symptomatic Meckel's diverticulum is managed by resection. The issue of prophylactic in incidental Meckel's diverticulum resection remains controversial.

Ileocecal Obstruction Due to B-cell Non-Hodgkin Lymphoma

We report a rare case of non-Hodgkin lymphoma presented as an ileocecal mass. The patient was a 77-year-old man with history of symptoms of partial bowel obstruction, intermittent right iliac fossa pain, loss of weight, vomiting and fatigue. Clinical signs included moderate abdominal tenderness with a palpable mass in the right iliac fossa at the physical examination. Colonoscopy revealed an intussusception of the right colon causing a complete stenosis. The patient developed complete bowel obstruction during hospitalization that required emergent surgical intervention. Intraoperatively an ileocecal mass was found measuring 10-12 cm in diameter, causing complete stenosis at its level and bowel dilatation proximally. Multiple nodules were found in the liver and the parietal peritoneum as well. An ileotransverso-anastomosis was performed and biopsies of the nodules were taken. Pathological evaluation revealed a diffuse large B cell non-Hodgkin'™s lymphoma of the ileocecum and the parietal peritoneum.

Lymphangitic spread from the appendiceal adenocarcinoma to the ileocecal valve, mimicking Crohn’s disease

Due to the anatomical peculiarity of the appendix, diagnosis of tumors arising from this area can be challenging by clinicoradiologic means. We report a case of a rare primary appendiceal signet ring carcinoma with an uncommon presentation. An 86-year-old woman was admitted to our hospital with subacute epigastric pain. Computed tomography demonstrated bowel wall thickening with fat stranding in the ileocecal region. The leading diagnostic consideration was inflammatory bowel disease. Upon colonoscopy, a swollen, distorted ileocecal valve was identified. The remaining colon was otherwise unremarkable. Extensive biopsy sampling of the ileocecal region and colon was performed. A lymphangitic signet ring carcinoma within the ileocecal region was diagnosed on biopsy; there was no dysplasia or carcinoma of the remaining biopsies. By cytomorphology and immunoprofile, a lymphangitic signet ring carcinoma of appendiceal origin was the primary consideration, further confirmed upon subsequent laparotomy. This case represents an unusual pattern of appendiceal tumor spread with localized, lymphangitic involvement, creating a milieu which closely simulates Crohn’s disease on imaging modalities.

Inflammatory Fibroid Polyp of the Ileocecal Valve: Case Report, Review, and Recent Advances

We report a case of a 72-year-old woman who underwent a right hemicolectomy for a near-obstructing mass in the ileocecal valve. The histologic diagnosis was inflammatory fibroid polyp (IFP). IFPs are rare mesenchymal lesions that can arise throughout the gastrointestinal tract. Originally considered reactive or inflammatory, recent studies report activating mutations of platelet derived growth factor receptor-alpha (PDGFRA) in IFPs, suggesting that these may in fact be neoplastic. Nonetheless, these are benign lesions cured by local excision and typically do not recur or metastasize. Our patient also had no evidence of local recurrence one year after the surgery. Hence, the clinical importance lies in distinguishing these lesions from other benign and malignant mesenchymal proliferative lesions both on a biopsy and resection specimen. We review the literature on clinicopathologic features, immunohistochemical profile, pathogenesis, recent advances, differential diagnosis, prognosis, and treatment of these uncommon lesions.

Acute abdomen: Rare and unusual presentation of right colic xanthogranulomatosis

Xanthogranulomatous inflammation (XGI) is a disease of unknown origin, most frequently described in the kidney and gallbladder; its localization in the colorectal tract is extremely rare. The extension of the typical inflammatory process to the surrounding tissues may lead to misdiagnosis as cancer. We report the case of a 56-year-old woman presenting to the Emergency Department with pain, increased levels of α1 and α2 proteins and C-reactive protein (17.5 mg/dL; normal value 0-0.5), and a palpable mass, localized in the right lower quadrant of the abdomen. A computed tomography scan showed a large right cecal mass with necrotic areas, local inflammation of retroperitoneal fat, and enlargement of local lymph nodes. Because of the high suspicion of colic abscess as well as malignancy and worsening of the clinical condition, the patient underwent right colectomy after 4 d of antibiotic treatment. Pathology revealed xanthogranulomatous inflammation involving the ileocecal valve. We review the reports of large bowel tract XGI in the international literature.

Double ileo-ceco-colic invagination due to right colon carcinoma: clinical presentation and management

Intestinal intussusceptions represent a rare cause of intestinal obstruction in adults (about 1% of intestinal obstructions). The principle causes are benign or malignant tumors. In adults, the most frequent localizations of intestinal invaginations are the ileo-cecal segment, ileum and colon as exclusive localization. We report the case of a 56 year-old Caucasian male admitted in our Department complaining with diffuse abdominal pain and severe anemia. The colonoscopy revealed a vegetant, stenosing and ulcerated mass in the hepatic flexure. The computed tomography suggested the additional diagnosis of intestinal intussusception with no evidence of intestinal obstruction. In our experience, surgery is always indicated for the treatment of intussusceptions in adults, especially for the almost constant underlying neoplasm.

Unusual cause of adult intussusception: diffuse large B-cell non-Hodgkin's lymphoma: a case report and review

BACKGROUND

Intussusception is defined as the telescoping of a segment of the gastrointestinal tract into an adjacent one. A demonstrable etiology is found in 70% to 90% of cases in adult patients, and about 40% of them are caused by a primary or secondary malignant tumor. The aims of this study were to give an overview of the literature on intussusception due to gastrointestinal lymphoma.

MATERIALS AND METHODS

We present a case of ileocecal intussusception secondary to non-Hodgkin's lymphoma (NHL), as well as a literature review of studies published in the English language on intussusception secondary to lymphoma, accessed through PubMed and Google Scholar databases.

RESULTS

Thirty-six published cases of intussusception caused by lymphoma were evaluated, and a case of ileocecal lymphoma in a 62 year-old woman is herein presented. In the reviewed literature, 33 reports meeting the aforementioned criteria were included in this review. The patients were aged from 16 to 86 years (mean, 48.2 +/- 19.0 y). Twenty-nine were male and seven were female. According to the localization of lymphoma, 24 patients had ileo-colic intussusception, 10 had enteric, and 2 had colic intussusception. In terms of the diagnosis, 34 patients were diagnosed with various types of NHL, and two patients were diagnosed with HL.

CONCLUSIONS

Despite the rarity of intussusception cases secondary to malignant causes, particularly lymphoma, it is rather difficult to diagnose preoperatively by surgeons. Because there exists a risk of malignancy in a substantial portion of adult intussusception cases, resection should be performed in a manner consistent with the oncological principles.

Colonic lipomas. Three surgical techniques for three different clinical cases

Colonic lipomas larger than 2 cm in diameter are likely to be symptomatic. In some cases a complication is the first clinical sign. Massive lower intestinal bleeding or obstruction, acute bleeding, prolapse or perforation or, rarely, acute intussusception with intestinal obstruction require urgent surgery. Diagnosis is often made following colonoscopy, which can also have a therapeutic role. Imaging procedures such as CT has a secondary role. Patients with small asymptomatic colonic lipomas need regular follow up. For larger (diameter > 2 cm) and/or symptomatic lipomas, resection should be considered, although the choice between endoscopic or surgical resection remains controversial. We believe that even lipomas > 2 cm can safely be removed by endoscopic resection. If surgery is indicated, we consider laparoscopy to be the ideal approach in all patients for whom minimally invasive surgery is not contraindicated.

Head or tail: the orientation of the small bowel capsule endoscope movement in the small bowel

BACKGROUND AND AIMS

The diagnostic accuracy of capsule endoscopy has been suggested to be influenced by the direction of the passage in the intestine. It is currently unknown if a head-first or a tail-first orientation are equally common during the descent through the small bowel. The aim of the study was to identify the orientation of the capsule along the migration through the small bowel.

METHODS

Thirty capsule endoscopies were reviewed by an experienced observer. The direction of the passage through the pylorus and the ileoceccal valve was recorded for all the examinations. In addition, detailed review of the passage of the capsule in different segments of the small bowel was undertaken for all the capsules.

RESULTS

The capsule was significantly more likely to pass the pylorus head-first compared to tail-first (25 and 5 out of 30, respectively, OR 5, 95% CI 65-94%, P < 0.001). In 28/30 studies, the capsule exited the ileoceccal valve head-first (OR-14, 95% CI 77-99%, P < 0.001). In an immersion experiment, uneven distribution of weight of the capsule body was demonstrated with the head part (camera tip) being lighter than the tail part.

CONCLUSIONS

The capsule endoscope usually passes through the pylorus and subsequent segments of the small bowel head-first. This observation suggests that the intestinal peristaltic physiology drives symmetrical bodies with their light part first. The principle of intestinal orientation by weight distribution may bear implications for capsules' design in the future.

[The ileocoecal valve changes in chronic constipation in children]

There were analyzed the results of treatment of 574 children, suf fering anatomic anomalies of a large bowel, in whom a chronic constipation was revealed. In 61 patients the ileoceocal valve (IV) insufficiency was noted. To all the patients together with complex conservative treatment there was prescribed a preparation, containing magnesium orotat, for restoration of the IV insufficiency. In 56 (91.8%) patients conservative treatment was effective and in 5--surgical intervention was conducted as a consequence of ineffective conservative treatment. Negative correlation dependence was established between a patient age and results of treatment.

Acute adult intussusception caused by primary cecal non Hodgkin lymphoma

Intussusception of the bowel is rather rare in adults and in about 80-90% of the cases is secondary to an underlying intraluminal pathology that serves as a lead point. In cases of colonic intussusception malignancy occurs in 63-66% of patients and it is usually adenocarcinoma and rarely lymphoma. The presenting symptoms are non specific and are in most cases of long duration, consistent with a chronic intussusception causing partial intestinal obstruction. We present a rare case of primary colorectal lymphoma in a 29 years old female that was complicated by acute ileocecal intussusception, treated with en bloc resection without reduction.

Focal lymphoid hyperplasia of the terminal ileum presenting mantle zone hyperplasia with clear cytoplasm. A report of three cases

We report three unusual cases of focal lymphoid hyperplasia of the ileocecal valve. The gross specimens showed thickening of the ileocecal valve. Low power magnification showed a dense lymphoid infiltrate in the mucosa and submucosa. This condition was characterized by reactive lymphoid follicles with large reactive germinal centers surrounded by a pale cuff of mantle zone lymphocytes presenting a marginal zone distribution pattern. These cells had intermediate- to- medium-sized round or slightly indented nuclei and a broad rim of clear cytoplasm. However, immunohistochemical study demonstrated that both the mantle zone lymphocytes and the pale cuff of the lymphoid cells were CD20+, sIgM+, sIgD+, CD5-, CD10-, CD23-, CD43-, Bcl-2+, Bcl-6-, CyclinD1-. The polytypic nature of these cells was demonstrated by immunohistochemistry and polymerase chain reaction. This unusual mantle cell hyperplasia with clear cytoplasm associated with focal lymphoid hyperplasia in middle-aged and elderly patients should be differentiated from the extranodal marginal zone B-cell lymphoma of mucosa associated lymphoid tissue type or mantle cell lymphoma showing a marginal zone distribution pattern. To avoid overdiagnosis and overtreatment, it is suggested that immunophenotypic and genotypic studies might be required, and careful attention should be paid to the morphologic examination.

[Clinical and pathological features of benign ileocecal ulcerative lesions discovered by ileocolonoscopy: analysis of 31 cases]

OBJECTIVE

To investigate the clinical and pathological features of benign ileocecal ulcerative lesions proven by ileo-colonoscopy.

METHODS

The clinical data of 31 patients, 17 males and 14 females, aged (47 +/- 17) (17 - 76) with distal ileal ulcers and/or ulcers of ileocecal valve, > or = 2 mm in diameter, confirmed by colonoscopy were analyzed.

RESULTS

The clinical manifestations included abdominal pain, lower right abdominal pain, diarrhea, constipation, hematochezia, fever, and body weight loss. Abdominal pain was found in 20 patients (64.5%) and lower right abdominal pain in 6 (19.4%). 20 patients had the ulcers 0.2 - 1.0 cm in diameter and the ulcers of 11 patients were larger than 1.0 cm. The sites of ulcers included ileocecal valve (17 cases), anastomotic stoma after resection of ileocecal valve (3 cases), distal ileum (7 cases), and both ileocecal valve and distal ileum (4 cases). Single ulcer was seen in 17 patients and multiple in 14. The ulcers were sharply demarcated,without remarkable inflammation around or between the ulcers. Histopathological findings were mostly unspecific, such as chronic inflammation, active inflammation, ulceration, eosinophil infiltration, inflammatory granulation, granuloma, and thickness of vessel wall. Mostly, the causes of ulcer were of unknown origin (14 cases), especially for those of small size (12 cases). 10 cases (32.3%) were diagnosed as Crohn's disease. The other diagnoses were intestinal tuberculosis, ischemia, Behcet's disease, AIDS, and NSAIDs-associated ulcers.

CONCLUSION

Most patients with benign ileocecal ulcers complain of abdominal pain, but lower right abdominal pain is not always present. The pathological findings are mostly not specific, but sometimes are critical for the diagnosis. The etiology was difficult to be confirmed and all the clinical data should be reviewed carefully.

New concept of ileocecal junction: Intussusception of the terminal ileum into the cecum

AIM: To prove that the terminal ileum is intussuscepted into the cecum creating the ileocecal junction, contrary to previous valvular concept which has been widely believed.

METHODS: This study is based on gross and microscopic examinations of fresh specimens derived from colonic operations (right hemicolectomy or subtotal colectomy). Data compiled from observing and dissecting of specimens of seven patients are used to examine both gross and microscopic appearance of ileocecal junction.

RESULTS: Intussusception of the terminal ileum was found in every specimen. However, the length of intussusception was different in each specimen.

CONCLUSION: Gross and microscopic appearance studies suggest that the terminal ileum is intussuscepted into the cecum.

[Radical surgical treatment of a new neuroendocrine tumor of the ileocecal valve with liver metastasis and carcinoid syndrome]

BACKGROUND

Neuroendocrine tumors are rare neoplasms which have a slow growth pattern. When liver metastases are diagnosed, treatment is controversial and it is focused in symptomatic control.

AIM

To present a patient with a neuroendocrine tumor that arised from the ileocecal valve and it was diagnosed with carcinoid syndrome and treated with radical liver and colonic resection. A discussion of the different forms of treatment is presented.

CASE REPORT

A 41 year-old woman was sent to our hospital with liver metastases and carcinoid syndrome from a neuroendocrine tumor of the ileocecal valve for treatment. Right colectomy, right hepatic trisectionectomy and radiofrequency ablation of two left sided lesions was performed as a first procedure. A second procedure was performed two months afterwards when resection of residual left sided lesions was done. After a two year follow up a 2 cm residual liver lesion was diagnosed and percutaneous radiofre-quency ablation was done. After four years of follow up the patient has been asymptomatic without tumor recurrence

CONCLUSIONS

Radical surgical treatment of neu-roendocrine tumors controls symptomatology, improving quality of life and survival. However, this treatment should only be performed in a well selected group of patients.

[Rare cases of intussusceptions in children]

Intussusception is common in children under two years of age. Most of them are idiopathic whereas intussusceptions secondary to focal pathologies are rare. We report of two unusual cases of ileocolic intussusception. In one child a mobile cecum was seen, in the second child a duplication cyst of the ileocecal valve.

Endometriosis involving the ileocaecal junction with regional lymph node involvement in the baboon—striking pathological finding identical between the human and the baboon: A Case Report

The baboon is an established model for endometriosis research. This report describes the occurrence of spontaneous endometriosis involving the ileocaecal junction and associated regional lymph nodes in the baboon. All endometriotic foci lacked the nuclear atypia, abnormal mitotic activity and altered nuclear-to-cytoplasmic ratio typical of malignancy. These findings are identical to reports in the human in which ileocaecal and colonic endometriosis is associated with endometriosis in pericolonic and mesenteric lymph nodes. The similarity between baboon and human colonic endometriosis in both location and pathology is striking and lends further evidence supporting the validity of the baboon as a model for human endometriosis.

Bauhin's ileocecal valve syndrome-a rare cause for small-bowel obstruction: report of a case

Benign ileocecal valve hypertrophy is a rare cause for intestinal obstruction. We describe a 51-year-old female with clinical and imaging presentation of chronic small-bowel obstruction. The patient was operated on, and a limited thickening of the ileocecal bowel wall causing intestinal obstruction was found. A right hemicolectomy was performed. On microscopic examination, severe fibrosis with hypertrophied nerves was found without any additional findings of malignancy or inflammation. Review of the relevant literature is presented.

An increase of CA 19.9 as the first clinical sign of ileocecal valve metastasis from breast cancer

CASE REPORT

The case of a breast cancer patient with a progressive increase of CA 19.9 that indicated gastrointestinal metastasis is reported. After the observation of an increased CA 19.9 serum value (104.00; n.v. 0.0-37.00) a colonoscopy was performed. This examination showed the presence of an erythematous and granular zone near the ileocecal valve. Histological examination of biopsies taken during the colonoscopy revealed atypical monomorphic cells between the organoid pattern of the colon-type ducts. Immunohistochemical staining was positive for cytokeratin 7 and for estrogen receptors, consistent with metastatic epithelial malignancy. After eleven months, the patient presented with signs of intestinal obstruction, requiring an ileocolic bypass. At definitive histological examination, the tumor exhibited features of mammary metastases.

CONCLUSION

This is the first report in the literature of an ileocecal valve metastasis from breast cancer diagnosed by an increase of CA 19.9, which is a marker of primary colorectal carcinoma.

Disposition of muscularis propria and nerve elements in the lip of the ileocaecal valve

The presence of a valve and the concept of a functional sphincter at the ileocaecal junction have been debated in the literature. Twenty four specimens of ileocaecal organ complex including 10cm of ileum and colon were obtained from cadavers from the Departments of Anatomy and Pathology, PGIMER, Chandigarh. 5 micron thick longitudinal sections from the upper lip of the ileocaecal valve were stained with Hematoxylin and Eosin and Silver stain. Sections of the ileum and colon from 5 ileocaecal organ complexes were also prepared and similarly stained. All the sections were viewed under the light microscope. The muscle bundles constituting the muscularis propria in the ileocaecal valve were arranged in two rows and were tapering in size from the base to the apex. The disposition of the muscle fibres was not uniform in all the specimens. The muscle fibers could be traced up to the upper, middle and lower third of the valve in 8 (33.3%), 14 (58.3%) and 2 (8.3%) specimens respectively. Silver stain of these sections revealed large numbers of nerve elements distributed within the submucosa and muscularis propria. The density of nerve elements in the ileocaecal valve was similar in all the sections irrespective of the extent of the muscularis propria and was comparable to the density of nerve elements in the muscularis propria and submucosa of the ileum and colon. The present study shows that the ileocaecal valve has a well developed muscularis mucosa and a proportionate component of the nerve elements.

Inflammatory myofibroblastic tumor with ALK/TPM3 fusion presenting as ileocolic intussusception: an unusual presentation of an unusual neoplasm

Inflammatory myofibroblastic tumor is a rare spindle cell lesion of indeterminate malignant potential occurring in both pulmonary and extrapulmonary tissues. This report describes an unusual presentation of an unusual tumor at an unusual location: an intramural ileal case of inflammatory myofibroblastic tumor presenting with intussusception in a 29-year-old woman. We characterize this tumor through microscopic and ultrastructural analysis, extensive immunohistochemical analysis, ploidy analysis, and Epstein-Barr virus in situ hybridization, and we report the finding of an ALK/TPM3 fusion using fluorescence in situ hybridization.

[Isolated edematous swelling of Bauhin's valve -- sonographically suspected diagnosis of a rare ileocoecal disease]

Isolated edematous swelling of Bauhin's valve is a rare finding in cases of non-specific abdominal complaints in the lower right abdominal quadrant. The differential diagnosis includes entities such as tumours, chronic gastrointestinal inflammation and ileocoecal intussusception as well as specific infections, all of which require individual therapy. Based on two current cases and a review of the literature, aetiology, clinical picture and diagnostic findings of isolated edema of the ileocoecal valve are described. The typical ultrasound findings are presented. Due to its potential of excluding other diseases, modern ultrasound offers promising results in the case of isolated edematous swelling of Bauhin's valve.

Cytomegalovirus colitis manifested with a ring like ileocecal valve ulcer in a Korean AIDS patient

A 32-year-old man, who had no previous medical history, was hospitalized with 3-week duration of abdominal pain, fever, and watery diarrhea. Initial colonoscopy showed subepithelial hemorrhagic spots throughout the entire colon together with well-circumscribed ulcer around the ileocecal valve. Serologic test disclosed HIV-positive and repeated biopsies at ulcer base finally revealed that the patient had cytomegalovirus ulcer in ileocecal area.

[Foreign body-induced disruption of the gastrointestinal tract-anatomy of the ileocoecal opening]

INTRODUCTION

Over 75% of ingested foreign bodies pass the gastrointestinal tract without any complications. Blunt foreign bodies may lead to a disruption of the intestinal passage, mainly in the area of the ileocoecal opening. The size of the reported foreign bodies varies considerably. The aim of this study was the anatomic investigation to clarify the possible causes of obstruction and its influence on the diameter of the ileocoecal opening.

MATERIAL AND METHOD

We investigate anatomically and describe the ileocoecal opening on the basis of 27 specimens.

RESULTS

We found not a flap mechanism but a valve mechanism in the ileocoecal junction. The median diameter of the formalin-fixated specimens was 10.9 mm respectively 21.8 mm according to an assumed correction factor of 2. The cause for intestinal obstruction most probably is the ingestion of blunt, angular foreign bodies in the ostium ileale.

CONCLUSION

The intraindividual differences as well as the considerable size of foreign bodies that pass the ileoceocal opening support the hypothesis, that the complications described are more a consequence of an ingestion of blunt, cornered foreign bodies in the ostium ileale independent ofn the size of the ileocoecal opening itself.