Correlation between a continent ileocecal valve and CT signs of severity in patients presenting with obstructive colonic cancer.

OBJECTIVE: To study the association of a continent ileocecal valve and the degree of severity of the CT signs in patients presenting with large bowel obstruction due to colonic cancer.

PATIENTS AND METHODS: Sixty-six patients undergoing emergency surgery for confirmed obstructive colonic cancer were included. The CT examinations were analyzed without consultation of the surgical results. For each patient, the diameter of the cecum at its widest point and that of the last ileal loop were measured. The ileocecal valve was considered incontinent when there was a distension of the last ileal loop greater than or equal to 25 mm. Below 25 mm, the ileocecal valve was considered continent. The presence of CT signs of severity of the LBO was noted, i.e., intestinal pneumatosis, absence of contrast enhancement of the large bowel wall, defect in the large bowel wall, and presence of extra-digestive air and ascites.

RESULTS: Among the 66 patients included, 42 had an incontinent ileocecal valve and 24 had a continental ileocecal valve. There was a statistically significant difference between the two groups in the diametrical measurements of the cecum's widest point (mean diameter measured at 10.3 cm in patients with continent ileocecal valve vs 8.4 cm in patients with incontinent ileocecal valve, P = 0.0023). Patients with a continent valve had statistically higher rates of CT severity (79% vs 40%, P < 0.005). Perforation of the cecum remained rare (8%) and was only observed in patients with continent ileocecal valve in our series.

CONCLUSION: Continence of the ileocecal valve appears to be statistically correlated both with cecum distension and the presence of CT signs of severity in patients with obstructive colonic cancer. As such, its presence must be retained as a risk factor for a pejorative evolution of this type of LBO and must be specified in the CT report of these patients.