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A lower gastrointestinal bleed is defined as bleeding originating distal to the ileocecal valve, which includes the colon, rectum, and anus. [2] LGIB was previously defined as any bleed that occurs distal to the ligament of Treitz, which included the aforementioned parts of the intestine and also included the last 1/4 of the duodenum and the entire area of the jejunum and ileum. [1]
The ileocecal valve is typically located on the last fold before entry into the cecum and can be located from the direction of curvature of the appendiceal orifice, in what is known as the bow and arrow sign. [4] Intubation of the ileocecal valve is typically performed in colonoscopy to evaluate the distal, or lowest, part of the ileum.
When caused by cancer, bowel perforation typically requires surgery, including resection of blood and lymph supply to the cancerous area when possible. When perforation is at the site of the tumor, the perforation may be contained in the tumor and self resolve without surgery. However, surgery may be required later for the malignancy itself.
It is caused by an incomplete obstruction of the small intestine and especially of the ileocecal valve, e.g. in Crohn's disease, or in rare cases of cancer of the small intestine. It is named after the German surgeon, Franz König (1832–1910), and should not be confused with König's disease, also named after him.
Since a segment including the large and small intestines is utilized, also included in this new system is the ileocecal valve. This is a one-way valve located between the small and large intestines. This valve normally prevents the passage of bacteria and digested matter from re-entering the small intestine.
Common causes of small bowel obstruction include post-operative adhesions, hernias, intussusception, and intraabdominal tumors. Common causes of colonic obstruction include primary colon cancer, volvulus and post-operative adhesions. When the ileocecal valve is competent, colonic obstruction may manifest as gaseous distention of the colon, but ...
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