| disease | Ileocecal Valve Syndrome |
| alias | Ileocecal Sphincter Syndrome, Ileocecal Valve Syndrome |
Ileocecal valve syndrome, also known as the ileocecal sphincter syndrome, refers to nonspecific edema of the ileocecal valve caused by various factors. Clinical manifestations include recurrent diarrhea, pain in the lower right abdomen, and weight loss. It is more commonly seen in young adult males and obese females. If the ileocecal valve, along with the protruding ileal mucosa, herniates into the cecum, it can be referred to as ileocecal valve prolapse syndrome, also known as lipomatosis of the ileocecal region.
bubble_chart Etiology
Rigler summarized the intrinsic disease causes into five categories: ① Edema: idiopathic or injury-induced; ② Herniation or prolapse of the ileal mucosa into the colon; ③ Submucosal fat accumulation; ④ Benign or malignant tumors of the ileocecal region; ⑤ Inflammation involving the ileocecal valve: parasitic (amoebic) or non-specific (Crohn's disease).
bubble_chart Pathological Changes
The ileocecal valve in this condition exhibits changes such as congestion, edema, and hypertrophy, with some cases even showing scar formation. Due to lesions in the ileocecal region, the reflex activity of the ileocecal sphincter becomes hyperactive, leading to spasm or hyperplasia of the sphincter. The terminal ileum must increase its activity to overcome this resistance, resulting in enhanced ileal peristalsis and accelerated propulsion of intestinal contents, which manifests as symptoms like abdominal pain and diarrhea. Smith suggests that hypertrophy of the ileocecal valve may be due to diffuse lipomatous infiltration.
bubble_chart Clinical Manifestations
The main symptoms include recurrent episodes of diarrhea, pain in the lower right abdomen, accompanied by weight loss. There may also be symptoms of digestive dysfunction such as decreased appetite, abdominal distension and fullness. Signs include tenderness in the lower right abdomen, but no rebound pain or muscle tension.
In cases of ileocecal valve prolapse, diarrhea and constipation often alternate. A mass may be palpable in the lower right abdomen, or there may be varying degrees of rectal bleeding.bubble_chart Auxiliary Examination
(1) Blood test: White blood cells are essentially normal.
(2) Barium enema examination: Typical filling defects can be seen in the ileocecal valve area, presenting as Rose Flower nodular, cap badge-like, mushroom-like, umbrella-like shapes, with local tenderness. The defect appears as a smooth round shape in the frontal view.
(3) Fiber colonoscopy: An important diagnostic tool. Inserted into the ileocecal region, it allows direct visualization of the ileocecal valve morphology.
The condition lacks specific clinical manifestations and is easily confused with chronic appendicitis. Diagnosis often requires X-ray barium enema or fiberoptic colonoscopy to detect typical changes in the ileocecal valve. In a few cases, exploratory laparotomy is necessary for a definitive diagnosis.
bubble_chart Treatment Measures
Most patients with mild symptoms can recover on their own without special treatment. For those with obvious symptoms, symptomatic treatment can be provided, such as sedatives being effective for abdominal pain, and antibacterial drugs being effective for diarrhea, especially when accompanied by intestinal flora imbalance.
If there is severe anatomical abnormality of the ileocecal valve, or severe symptoms, ineffective medical treatment, complications such as intestinal stenosis, intestinal obstruction, massive rectal bleeding, or difficulty in distinguishing from acute or chronic appendicitis, surgical treatment may be considered. For prolapsed ileal mucosa, cecal incision may be performed for reduction. For benign small tumors limited to the ileocecal valve, they can also be removed by high-frequency electrocoagulation via fiber colonoscopy.
