Comparison of plicated and stapled continent ileocecal stoma.

Tapered terminal ileum and an intact ileocecal valve have been shown to be an effective efferent continence mechanism in patients with continent ileocecal urinary reservoirs. The terminal ileum can be tapered by simple suture plication or with linear gastrointestinal stapling devices. We used precise urodynamic techniques to study 21 continent urinary reservoirs constructed from ileocecal bowel segments: 14 with plicated segments and 7 with stapled segments. Mean contraction pressures tended to be higher in the latter (P = 0.054), although maximum contraction pressures were similar (P = 0.48). Terminal ileum tapered with the gastrointestinal stapling device and an intact ileocecal valve provide for an effective efferent continence mechanism that is easy to construct and catheterize.     

A Novel Technique to Relieve a Closed-Loop Obstruction Secondary to a Competent Ileocecal Valve and an Unresectable Mid-Colon Tumor

A competent ileocecal valve complicates the surgical treatment of an unresectable obstructing mid-colon tumor. Specifically, it may not be feasible to bypass with a colocolotomy, especially when the sigmoid colon has limited mobility or if the ascending colon is severely distended and edematous. A technique is described in which the closedloop obstruction is relieved at its proximal extent by an ileocecal valvuloplasty. A circular stapling device is fired across the ileocecal valve. Once the ileocecal valve is rendered competent, a loop ileostomy or a colocolotomy can be constructed, providing effective palliation for this difficult situation.     

Ileocecal resection in neonates a follow-up study

From 1977 to 1982 ileocecal resection was done in five neonates admitted to our pediatric surgical units. The growth and development of these infants were examined and comparisons were made with age matched controls. Two who had undergone ileocecal resections had a slight diarrhea. Physical examination, hematology and blood chemistry, including serum levels of rapid turnover proteins, were all within the normal ranges. Significant differences between data on these patients and the controls were not noted. Our findings indicate that ileocecal resection with less extensive ileal resection can be done in neonates as an adequate nutrition is physiologically feasible.     

Ileozökale Invagination aufgrund eines benignen Dünndarmtumors

We report a case of postoperative ileocecal invagination in a 63-year-old male. Forty-six days after esophageal resection and gastric tube reconstruction with cervical anastomosis for an esophageal carcinoma, the patient suffered from colicky pain in the right abdomen. The diagnostics showed an ileocecal invagination up to the right flexure of the colon. The invagination was based on a leiomyoma of the terminal ileum. Because of necrosis of the mucous membrane, an ileocecal resection with ileoascendostomy could not be avoided. We discuss this case on the basis of the existing literature.     

Atresia of the Ileocecal Junction with Agenesis of the Ileocecal Valve and Vermiform Appendix: Report of a Case

Intestinal atresia involving the ileocecal region is a very rare intestinal malformation, and the presence or absence of the ileocecal valve influences its surgical management. We report the case of a male newborn with a provisional diagnosis of distal ileal atresia, in whom laparotomy revealed that the entire ileocecal region was atretic with an absent ileocecal valve and appendix vermiformis. We resected the dilated terminal ileum together with the atretic segment and performed an ileocolic anastomosis between the terminal ileum and the transverse microcolon without valve reconstruction. When last seen, 8 months after the operation, the baby was developing normally. Ileocolic anastomosis without valve replacement appears to be sufficient if an ileocecal valve is completely absent and only a short segment of the terminal ileum is lost.     

Laparoscopic resection for malignant lymphoma of the ileum causing ileocecal intussusception

A 22-year-old man was admitted with right lower abdominal pain. Colonoscopy revealed a ball-like tumor at the ileum. Abdominal sonography and computed tomography showed ileocecal intussusception. Microscopic examination of the biopsy specimen showed malignant lymphoma. Laparoscopic ileocecal resection was performed. Histologic diagnosis of the resected tumor was diffuse large B cell-type malignant lymphoma. Intussusception due to malignant lymphoma is relatively rare in adults. If contraindications of laparoscopy are not present, laparoscopic resection can be performed safely and should be considered for diagnosis and treatment for intussusception in ileocecal lesions in adults.     

Small bowel obturation ileus related to ingestion of a medical device

We report the case of a 50-year-old woman who was admitted to the hospital with an acute abdomen and underwent exploratory laparotomy. Intraoperatively, we suspected Crohn's disease of the ileocecal valve and decided to treat conservatively. However, in the further clinical course the patient became severely sick and developed a necrotizing ileocecal inflammation in combination with multiple perforations, 4-quadrants peritonitis and several other complications. Histopathology revealed an unspecific inflammation of the ileocecal valve. Furthermore, numerous little cellulose sponges were found in the resected intestinal segment. They were obstructing the lumen and were identical with the contents of an appetite suppressing medical device. A connection between the ingestion of this medical device and the penetrating inflammation of the ileocecal valve has to be suspected.     

回盲部肿块的临床及CT表现—附21例临床分析

目的:复习回盲部肿块的CT表现,以期对肿块在术前提出诊断。方法:21例经手术或活检证实的回盲部肿瘤,行CT平扫15例,平扫加增强扫描6例。结果:CT扫描见2例为囊性,19例为实性。结论:我们分良、恶性两组,讨论了良、恶性肿块的鉴别诊断,认为CT可区别肿块的囊实性,对鉴别肿块的良、恶性及确定病变范围有较大价值。根据CT表现,结合临床对回盲部肿块大多可作出定性诊断。     

Das inkompetente Nabelstoma

Besides common requirements like universal applicability, reproducibility, and low complication rate, functionality and cosmetic aspects are essential in continent cutaneous diversions. Creation of the continence mechanism certainly represents the major surgical challenge in continent cutaneous diversions. Complete continence and ease of catheterization are mandatory for the patient's quality of life.High surgical competence, creativity, and variability are required in cases of revisional surgery for stomal insufficiency. In addition to accurate preoperative clinical, endoscopic, and radiologic evaluation, extensive expertise in the fields of continent urinary diversion and reconstructive urology allows performance of a surgical solution ideally adapted to the patient's individual situation. Between January 1990 and September 2011 we performed urinary diversion in 1,224 patients (mean follow-up 90.3 months). Continent urinary diversion was performed in 717 patients (59%); in 486 patients an ileocecal reservoir with continent cutaneous diversion, in 186 patients an ileocecal neobladder, and in 45 patients a sigma rectum pouch was created. Incontinence rate and stenosis rate in patients with appendico-umbilical stoma (n=219) were 2.3% and 10% and in patients with intussuscepted ileum nipple (n=267) nipple 5.2% and 2.7%. Stenosis usually can be corrected easily by simple excision of the obstructive scarred tissue or by stomal reconfiguration. Outlet failure may result from simple causes like fistula formation between reservoir and efferent segment or skin and nipple gliding or prolapse which can easily be repaired. More complex situations might require creation of a secondary continence mechanism. In our series of 486 patients having undergone continent cutaneous diversion in our department, 14 patients (appendico-umbilical stoma n=5, ileal nipple n=9) suffered from irreversible damage of the continent outlet. In 11 patients creation of a secondary intussuscepted ileal nipple and in 3 patients a modified Managadze procedure was performed.In case of absence of the ileocecal valve (e.g. in primary ileal reservoirs, ileocolonic reservoirs without integrated ileocecal valve) and in case of a preexisting pouch of small capacity we prefer augmentation of the primary reservoirs with an ileocecal cup patch plasty in combination with the submucosally embedded appendix or intussuscepted ileal nipple serving as continent outlet. In our institution this was done in four patients who had undergone primary surgery elsewhere.     

Inflammatory Myofibroblastic Tumor of the Ileocecal Mesentery Mimicking Abdominal Lymphoma in Childhood: Report of Two Cases

An inflammatory myofibroblastic tumor is an uncommon benign tumor located in various organs that can be misdiagnosed as a malignant neoplasm. We herein present two patients with ileocecal inflammatory myofibroblastic tumors. An abdominal mass was detected in a 13-year-old girl and a 15-year-old boy who presented with paleness, fatigue, intermittent fever, and night sweating. The radiological findings confirmed a mass originating from the ileocecal region. The presumptive diagnosis was Burkitt’s lymphoma. The histopathological diagnosis was inflammatory myofibroblastic tumor. After a surgical resection, all systemic symptoms rapidly resolved. Inflammatory myofibroblastic tumor is a rare pseudosarcomatous clinical and pathological entity. Although this tumor is more commonly reported in the lung, it can be detected in extrapulmonary sites, including the mesentery. Because the choice of treatment for this tumor is conservative surgery, an accurate preoperative analysis is important to avoid any unnecessary aggressive surgical intervention or other therapeutic approaches.     

Construction of an antirefluxing urinary conduit using a plicated ileocecal segment

A plicated ileocecal segment was used to construct an antirefluxing urinary conduit in 3 patients. Each patient had markedly dilated or shortened ureters that prevented conventional Leadbetter ureteral reimplantation into a colon conduit. Ascending colon was brought out as a cutaneous stoma, the ureters were anastomosed to ileum, and an antireflux mechanism was created from plicated terminal ileum and the native ileocecal valve. Significant reflux was prevented in all 3 patients. This technique provides a means to prevent urinary reflux into short or dilated ureters, and increases the versatility of the ileocecal segment for use in diversion and urinary tract reconstruction.     

Excisional Plication of the Ileocecal Valve: A Useful Adjunct for the Construction of Continent Urinary Diversions

Purpose

A variety of techniques exist to reinforce the ileocecal valve for use as a nonrefluxing mechanism in continent urinary diversion. We report short-term and long-term followup for a new technique of excisional plication of the valve.

Materials and Methods

Since 1988 we performed 16 procedures in 15 patients. The technique was used for repair of an incompetent ileocecal valve to restore continence in 2 patients in whom continent cutaneous diversion failed, and to correct a massively refluxing ileocecal valve following previous augmentation with an ileocecal segment in 1. The remaining patients underwent the procedure in conjunction with continent cutaneous ileocecal diversion with a modified Indiana pouch.

Results

To date no patient undergoing continent cutaneous diversion required reoperation to correct incontinence. Two patients wear a protective pad during the day, while the remainder have been completely dry during followup.

Conclusions

Excisional plication is a versatile and simple procedure that may be used to assist construction and repair of ileocecal valves in conjunction with continent urinary diversion.     

Enteric duplications presenting as antenatally detected abdominal cysts: is delayed resection appropriate?

Purpose: The aim of this study was to evaluate delayed elective resection of antenatally detected enteric duplication cysts.Methods: A retrospective casenote study of intraabdominal cysts detected antenatally between January 1991 and January 2002 found 37 fetuses with cysts. Twelve were enteric duplications. Two were duodenal, 1 was an 85-cm tubular jejunoileal duplication, and 9 were ileocecal. Asymptomatic cysts were followed with serial ultrasound scars and resected electively over 14 months.Results: Three neonates had small bowel obstruction demanding laparotomy: 1 of the 2 infants with duodenal duplication cysts, 1 infant with an ileocecal duplication, and the infant with the tubular duplication. One with an ileocecal duplication became symptomatic at 2 months and underwent a laparotomy. Seven had their duplications resected electively between 6 weeks and 14 months, and the other is still being followed. Four of the 7 asymptomatic duplications electively resected contained gastric mucosa.Conclusions: Intraabdominal enteric duplication cysts are increasingly likely to be detected antenatally. The majority are likely to remain asymptomatic for several months at least, after which a resection can be planned. The prevalence of gastric mucosa suggests that they should not be left indefinitely. Laparoscopically assisted resection of ileocecal duplications is safe and effective.     

回盲部恶性肿瘤的诊治

目的：分析回盲部恶性肿瘤的诊断和治疗过程，总结经验．以期提高早期确诊率和患者生存率。方法：回顾性分析近5年53例住院治疗的回盲部恶性肿瘤患者的临床资料。结果：53例患者中腺癌、黏液腺癌50例，恶性淋巴瘤3例。首次确诊率为75．5％。误诊或延迟诊断的疾病主要为阑尾炎、阑尾脓肿，胆囊炎、胆石症、下消化道出血、贫血待查等。结论：60岁以上的老年患者为回盲部恶性肿瘤的主要人群，肿瘤类型主要为腺癌。尽管首发症状缺乏特异性，但提高警觉性，详细询问病史，通过大便隐血试验、钡灌肠或气钡双重造影、纤维结肠镜检查仍能有效的提高首次确诊率，积极手术冶疗，可显著改善患者的预后。     

Ileocecal valve as substitute for the missing pyloric sphincter after partial distal gastrectomy

OBJECTIVES: Accelerated gastric emptying (including dumping syndrome) occurs frequently after gastric resections, largely resulting from rapid entry of meal contents into the small intestine. The authors hypothesized that an ileocecal segment used as an interpositional graft placed between the remaining part of the stomach and the small intestine would slow down food transit and thus replace pyloric function. METHODS: Thirty G?ttingen minipigs were randomized into three groups. Group 1: partial gastrectomy and Roux-en-Y reconstruction; Group 2: partial gastrectomy and ileocecal interpositional graft; and Group 3: sham laparotomy. Gastric emptying in the nonsedated animals was quantified using radioscintigraphy at 3 and 6 months postoperatively. The animals ingested 300 grams of soft food containing 99mTc labeled resin- pellets using a technique previously described. Data were analyzed using ANOVA. RESULTS: Three months postoperatively, the ileocecal group had a significantly prolonged gastric emptying time compared with the Roux-en-Y group, but gastric emptying time was also significantly faster compared to the control group (sham laparotomy). After 6 months no significant difference was seen between the ileocecal group and the controls, while emptying rates were still significantly faster in the Roux-en-Y group. CONCLUSIONS: Reconstruction of the gastric reservoir with an ileocecal segment largely restores gastric emptying patterns of food in minipigs. Six months postoperatively, gastric emptying time is similar to that of controls, and significantly slower when compared with the group with Roux-en-Y reconstruction. These results suggest that the ileocecal interposition graft could offer specific advantages over current reconstruction procedures.     

New Surgical Technique for Primary and Secondary Voice Restoration Using a Free Ileocecal Patch Graft After Total Laryngectomy

Purpose. We devised a new surgical technique to restore the voice after laryngectomy. This procedure is designed to repair the hypopharyngeal defect by using a free ileocecal patch for voice rehabilitation. Methods. We performed this procedure in seven patients; for primary voice restoration in six and for secondary voice restoration in one. The technique involved resecting an ileocecal segment containing the ileocecal valve and cutting a patch from the cecum, the size of which was equalized with the hypopharyngeal defect. After patch repair of the defect, the tracheopharyngeal shunt was completed by an anastomosis between the ileum and trachea. Results. One patient died from sudden rupture of the carotid artery, but all six survivors were able to speak and swallow without aspiration, achieving fair to good articulation. Conclusions. The advantages of our method are as follows. (1) The operative procedure is simple and does not require complicated remodeling of the intestinal graft for voice production. (2) The ileocecal valve can prevent aspiration. (3) The patch expands the pharynx and prevents narrowing. (4) Using this procedure, it is possible to achieve voice restoration even in patients who have undergone total laryngectomy in the past.     

Urodynamic evaluation of patients with continent urinary diversion using cecal reservoir and intussuscepted ileocecal valve

Patients requiring bladder removal for malignant disease have undergone continent urinary diversion employing the ileocecal segment, using the cecum to construct a reservoir and an intussuscepted ileocecal valve as the continence mechanism. Five of these patients have been studied urodynamically and radiographically in the postoperative period. Incontinence was found to be minimal and related only to a prolonged catheterization interval. Passive filling pressure and peristaltic pressure remained low in all patients and was lower than the nipple valve pressure in 4 of 5 patients. A transient increase in reservoir pressure at capacity with peristalsis exceeded the nipple peristaltic pressure in 1 patient and was associated with a small volume of incontinence. This resolved with a shortened catheterization interval. Reflux was not found in any subject studied. These studies indicate that the cecal segment can be used to construct a continent urinary reservoir that provides satisfactory function for the patient while maintaining an acceptable pressure volume relationship.     

A proposal to preserve the ileocecal valve and right colon in total colonic aganglionosis

We report two cases of total colonic aganglionosis in which the ileocecal valve and right colon were preserved. The aganglionic ileal segment is removed leaving behind only a very short prececal remnant, which is anastomosed end-to-back to the remaining ileum. An ileal loop (of approximately 20 cm in length) is isolated and interposed between the right colon and rectum. The operation can be performed as a staged procedure. The advantage of preserving the ileocecal valve with respect to physiology is discussed.     

Infarction of the ileocecal fold of Treves: a case of right lower quadrant pain

The ileocecal fold of Treves is a peritoneal structure extending from the antimesenteric surface of the terminal ileum to the base of the appendix. No known pathologic conditions have been previously associated with it. We report a 30-year-old woman with acute onset of right lower quadrant pain. Her history was atypical for appendicitis. Endovaginal ultrasonography did not reveal gynecologic pathology. After a period of observation, the patient underwent diagnostic laparoscopy. This revealed inflammation and necrosis of the ileocecal fold of Treves and a normal-appearing appendix. The lesion was removed and appendectomy was performed. The patient's symptoms resolved immediately after surgery. Histopathologic examination of the lesion revealed fat necrosis, hemorrhagic necrosis, and lymphocytic infiltration. The appendix was normal. In conclusion, infarction of the ileocecal fold of Treves may be included in the differential diagnosis of right lower quadrant abdominal pain. Laparoscopy facilitates the diagnosis and treatment of unusual abdominal lesions.     

Ileocecal masses discovered unexpectedly at surgery for appendicitis

During the past five years we have encountered 15 patients who were found to have an ileocecal mass of undetermined etiology when explored through a right lower quadrant incision for presumed appendicitis. Diverticulitis of the ileocecal region accounted for almost one-half of these lesions. There are many possible etiologies for mass lesions in this location, but beacuse malignancy cannot be excluded at operation, a right hemicolectomy is advised. We found that this procedure could be done with relative safety in unprepared bowel under emergency conditions.