Original communication| Volume 16, ISSUE 3, P356-369, September 1944

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Experimental observations on the human ileocecal valve

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      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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