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Abstract
The factors which determine the state of closure of the ileocecal sphincter such as
the pressure of material in the bowel, that is distention, were not operative in this
patient as all intestinal content introduced orally was shunted to the exterior through
a proximal fistula.
It was observed that retraction or shortening of the ileocecal structure occurs when
the segments are coordinated to accept a propulsive wave from an adjacent segment.
The ileocecal valve during a propulsive contraction is obliterated by retraction of
the frenula and the disappearance of the mucosal folds of the valve as they are retracted
over the contracted musculature of the intracecal terminal ileum. A nonpropulsive
or segmental wave is not associated with shortening of the active segment and the
valve is not obliterated. The ileocecal valve is most readily visualized during periods
of inactivity or diminution of tonus in the sphincter area.
The ileocecal valve is generally considered to have a passive mechanical function
dependent12 upon a complete frenulum (type I ileocecal valve was found6 to occur in 54 per cent of 500 human cecums) and increased intracecal tension whereby
the lateral and medial frenula are made taut, closing the arches of the valve. In
addition to this adynamic action of the ileocecal mucosal folds, the valve has been
shown to be capable of approximation of the lips by muscular contraction (Figs. 1
and 2). Independent contraction of the valvular lips and sphincter resulted by varying
the intensity of the stretch stimulus. In addition to the records of contraction the
examining finger has been gripped by the mucosal lips.
The observations of Wesson,13 and White and associates5 were confirmed as to the presence of a definite contracting muscular band within
the cecal portion of the terminal ileum proximal to the mucosal lips. Boyden examined
this area and suggested it may be located in the aperture of the colon where the ileum
passes through the cecal wall. When contracted the intestinal lumen completely excludes
the introduction of an instrument beyond the sphincter without a force far exceeding
the pressures found by Wangensteen14 and Sperling15 within the colon in cases of colonic obstruction. Rutherford, White and co-workers,
and Wesson have mentioned the difficulty of forcing the sphincter from the cecal side.
An opportunity to determine the resistance of the sphincter from the ileal as well
as the cecal side was overlooked in this study.
The inhibitory effect of increased intraluminal tension, intracolonic and intravesical
pressure, upon the contraction of the sphincter may upon occasion be one of the physiologic
factors underlying incompetency of this junction when the type of ileocecal valve
due to its variable structure would not justify an expectation of competency.
The reports of others7, 16, 17, 18 have repeatedly indicated the species difference of the reaction of the sphincter
and valve to adrenergic substances. The reaction of the human ileocecal valve and
sphincter following the injection of epinephrine-like substances and other drugs justifies
the assumption that these structures behave not unlike the small intestine. Wesson13 and I19 agree that the presence of an extracircular muscle in a large number of embryonic
and adult specimens of the intracecal terminal ileum was not observed upon microscopic
examination of innumerable serial sections.
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Buirge, Raymond E.: Unpublished data.
Article info
Publication history
Received:
December 10,
1943
Footnotes
☆Aided by a grant from the Graduate School, University of Minnesota.
Identification
Copyright
© 1944 Published by Elsevier Inc.
