A LOOK BACK

Lawrence R. Schiller, MD, MACG, for the ACG Archives Committee A LOOK BACK A LOOK BACK

50 YEARS AGO...

from the pages of The American Journal of Gastroenterology

By Lawrence R. Schiller, MD, MACG for the ACG Archives Committee

With colonoscopy now a routine procedure, we forget that observing the ileocecal junction in living human beings was an unusual event not that long ago. This report highlights the appearance and function of the ileocecal junction as viewed through a cecostomy.

“This report summarizes the observations made by one of the authors (DiDio) on the termination of the ileum in the large intestine in nine living subjects and describes the tenth patient whose ileal opening and surrounding area were exteriorized and examined in detail. When the termination of the ileum is viewed through a cecostomy or through a cecocolostomy, it is found to protrude into the lumen of the large intestine for a distance of 2–3 cm and is ensheathed by the surrounding colon and cecum. The anatomic configuration is that of a “papilla” with a star-shaped orifice. There is no evidence for the concept of a “valvular” mechanism at the junction between the small and large intestines. Functionally, the musculature of the ileal papilla acts as a pylorus, similar to the gastroduodenal and biliopancreatic pylori. We agree that this structure should be renamed the ileal “papilla”, as has been proposed by others.” —J. C. Rosenberg & L. J. A. DiDio. In vivo appearance and function of the termination of the ileum as observed directly through a cecostomy. Am J Gastroenterol 1969;52(5):411–9.

Figure 1: Exteriorized and incised cecocolic junction of a patient (J.S., 71-year old African American male, North American). Through the incision the mucosal surface of the large intestine is seen. The termination of the ileum is conic with truncated apex, justifying the name of “ileal papilla” (2 cm high, 2.5 cm in diameter at the base and 2 cm in diameter at the apex). A semilunar orifice, concave dorsally, is observed at the apex of the papilla.

Figure 2: Open orifice of the terminal ileum discharging semisolid ileal contents (same case as Fig. 1). The size of the ileal papilla increased during emptying of the terminal ileum and decreased afterwards.

Figure 1