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Concept: Ileocecal valve


To explore whether patients with a defective ileocecal valve (ICV)/cecal distension reflex have small intestinal bacterial overgrowth.

Concepts: Bacteria, Digestive system, Large intestine, Intestine, Gastroenterology, Small intestine, Small bowel bacterial overgrowth syndrome, Ileocecal valve


INTRODUCTION: Although both appendiceal tumor and intestinal endometriosis have been reported as rare causes of abdominal pain, the coexistence of appendiceal mucinous neoplasm and ileal endometriosis has not previously been reported. CASE PRESENTATION: A 41-year-old Japanese woman presented with a positive fecal occult blood test and a 3-year history of menstruation-related lower abdominal pain. A colonoscopy demonstrated extrinsic compression of the cecum, suggesting a mass arising from the appendix or adjacent structures. Abdominal imaging showed a 6-cm cystic mass with intraluminal thick fluids originating from the appendix. At ileocecal resection for an appendiceal tumor, a 2-cm mass in the terminal ileum was incidentally found, which was included in the surgical specimen. Microscopic examination confirmed a diagnosis of a mucinous neoplasm of the appendix with endometriosis of the terminal ileum. CONCLUSIONS: To avoid urgent surgery for subsequent serious events associated with disease progression, appendiceal tumor and intestinal endometriosis should be ruled out in patients with chronic abdominal pain.

Concepts: Ulcerative colitis, Crohn's disease, Large intestine, Gastroenterology, Small intestine, Fecal occult blood, Cecum, Ileocecal valve


A modified Michelassi strictureplasty over the ileocaecal valve or ileocolic anastomosis could be an alternative for ileocaecal resection. This study assessed the outcome of the modified Michelassi strictureplasty in patients with extensive stenotic terminal ileal Crohn’s disease (CD).

Concepts: Medical terms, Digestive system, Crohn's disease, Gastroenterology, Small intestine, Ileum, Strictureplasty, Ileocecal valve


The aim of this study was to examine whether the combination of dietary soluble fiber and cellobiose exert a synergistic effect on growth performance, health status, fermentation traits, and immune response in rabbits. Six treatments in a 3 x 2 factorial arrangement were used: 3 cellobiose concentrations in drinking water (0.0, 7.5, and 15.0 g/L) × 2 dietary levels of soluble fiber (84.0 and 130 g/kg DM, for the low soluble fiber (LSF) and high soluble fiber (HSF) diets, respectively). A total of 318 young rabbits (53/treatment) were weaned at 34 d of age and had ad libitum access to feed and water. At 46 d of age 9 rabbits/treatment were slaughtered and ileal and cecal digesta were collected to analyze VFA profile and the immune response in the cecal appendix mucosa. At 48 d of age the cellobiose supplementation was withdrawn and the experimental diets were replaced by a standard commercial diet until 61 d of age. From 34 to 48 d of age there was a linear increase of mortality with the level of cellobiose in the HSF group (0 vs. 17.1%; P = 0.017). In contrast, a quadratic effect of cellobiose level on mortality was observed in the LSF group, the rabbits offered 7.5-cellobiose showing the lowest mortality (5.7 vs. 21.4%; P = 0.030). Cellobiose level had a quadratic effect on ADFI, ADG, and G:F in this period (P ≤ 0.047), with the 7.5-cellobiose groups having the best growth performance. In contrast, only minor changes on these traits were observed from 48 d of age onwards. Cellobiose level influenced quadratically the ileal VFA concentrations (P = 0.014), showing the maximal value in the 7.5-cellobiose groups. In rabbits fed 7.5-cellobiose-LSF a change of acetate to propionate, butyrate, and valerate was observed in the ileum. Increasing cellobiose levels reduced linearly cecal VFA concentrations in HSF fed rabbits, but no effect was detected in LSF groups (P = 0.046). The level of soluble fiber increased VFA concentrations in both the ileum (by 22%; P < 0.001), and the cecum (by 11%; P = 0.005). The relative gene expression of IL-6, IL-10, TNF-α, iNOS, MUC-1, and toll like receptors (TLR-2 and TLR-4) in the cecal appendix increased linear and quadratically with increasing levels of cellobiose (P ≤ 0.063). In conclusion, in rabbits fed LSF diets a dose of 7.5 g cellobiose/L drinking water would be recommended, whereas these levels of cellobiose supplementation should be avoided in rabbits fed HSF diets.

Concepts: Immune system, Toll-like receptor, Vermiform appendix, Ileum, Cecum, Ileocecal valve, Midgut, McBurney's point


Appendiceal or cecal endometriosis with intestinal metaplasia is uncommon and may mimic mucinous tumors of the appendix. A 50-year-old woman was found incidentally to have an ileocecal lesion. In the intraoperative histological examination, a diagnosis of neoplasm of the cecum was made predominantly based on mucin extrusion with scattered lining mucinous epithelium. However, postoperative histological diagnosis of the lesion was cecal endometriosis with intestinal metaplasia as determined by thoroughly microscopic inspection and the presence of typical endometrial glands with surrounding endometrial-type stroma. There was no evidence of recurrence and pseudomyxoma peritonei after 1 year of follow-up. Overinterpretation of cytological atypia or mucin extrusion in endometriosis may lead to inappropriate surgical management. Therefore, in any ileocecal or appendiceal lesions with mucinous epithelia and mucin extrusions, removal of sufficient tissue from different portions of the lesion is essential for surgeons and pathologists to make a precise diagnosis in the intraoperative histological examination.

Concepts: Cancer, Epithelium, Anatomical pathology, Histology, Large intestine, Medical signs, Endometrium, Ileocecal valve


In this study, we aimed to assess the diagnostic yield of terminal ileum intubation during routine colonoscopy.

Concepts: Crohn's disease, Colonoscopy, Ileum, Cecum, Ileocecal valve, Terminal ileum, Ileocecal fold


Endoscopic mucosal resection (EMR) of peri-appendiceal sessile laterally spreading lesions (PA-LSLs) is technically demanding due to poor endoscopic access to the appendiceal lumen and the thin colonic wall at the base of the cecum. We aimed to assess the feasibility and safety of EMR for PA-LSLs.

Concepts: Ileocecal valve


An 84-years old woman, medicated with acenocumarol, was admitted to the Emergency Room with lower abdominal pain and nauseas and no history of trauma. She was medicated with acenocumarol and had a non-measurable international normalized ratio. The findings of the bowel ultrasound, ileocolonoscopy and biopsies specimens were suggestive of intramural bleeding of the ileum, ileocecal valve and cecum. Spontaneous intramural bleeding of the gastrointestinal wall associated with oral anticoagulation is rare.

Concepts: Digestive system, Ulcerative colitis, Large intestine, Intestine, Gastroenterology, Bowel obstruction, Diverticulitis, Ileocecal valve


Endoscopic resection of polyps located at the appendiceal orifice (AO) is challenging, and the feasibility and outcomes of endoscopic resection for cecal polyps involving AO are unconfirmed.

Concepts: Colonoscopy, Ileocecal valve


Contaminated pork is a significant source of foodborne Salmonella infections. Pork is contaminated at the slaughterhouse; however, the mechanisms driving Salmonella contamination of carcasses are still poorly understood. The aim of this study was to investigate whether the amount of Salmonella carried by slaughtered pigs in their guts has an influence on carcass contamination. On that account, we tested whether the number of carcasses contaminated during a slaughter day was associated with the prevalence of highly contaminated pigs (HCP: Salmonella caecal loads ≥3log/g), or with the prevalence of pigs that simply carry Salmonella spp. in their guts. Three hundred and six pigs were sampled in a slaughterhouse from Central Italy. Salmonella loads in the caecum and on the carcass of each pig were estimated by the most probable number (MPN) technique. The overall prevalence of Salmonella was 34.64% and 7.19% for the caeca and carcasses, respectively. S. Derby and S. 4, (Bonardi et al., 2003),12:i:- were the most frequently isolated serovars. The prevalence of HCP was 11.44%. We found a higher number of contaminated carcasses on days of high prevalence of HCP than on days of low prevalence of HCP (p=0.0011). Conversely, carcass contamination did not vary with the prevalence of pigs that simply carried Salmonella spp. in their guts (p=0.7970). Therefore, the prevalence of HCP, but not the prevalence of pigs carrying Salmonella spp., was related to carcass contamination. Taken together, these findings suggest that reduction of Salmonella loads in the guts of slaughtered pigs would result in fewer contaminated carcasses, and consequently, help to minimise the risk of human infection due to the consumption of contaminated pork.

Concepts: Salmonella enterica, Salmonella, Pig, Wild boar, Foodborne illness, Gastroenteritis, Cecum, Ileocecal valve