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Ileocecal Valve: Spectrum of Normal Findings at Double-Contrast Barium Enema Examination¹

¹ From the Departments of Radiology (L.C.E., M.S.L., S.E.R., I.L.) and Medicine (J.N.S., M.L.K.), Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104. Received April 2, 2002; revision requested June 12; revision received June 19; accepted July 25. Address correspondence to M.S.L. (e-mail: levine@oasis.rad.upenn.edu).

View larger version (109K): [in a new window]   Figure 1. Nonvisualized ileocecal valve. Close-up view of an overhead image from a double-contrast barium enema examination with the patient in the right lateral decubitus position shows tapered narrowing (arrow) of the terminal ileum where it enters the cecum but no evidence of a surrounding protrusion.

View larger version (104K): [in a new window]   Figure 2. Normal-appearing ileocecal valve. Spot radiograph from a double-contrast barium enema examination with the patient in the supine position shows a large ovoid ileocecal valve (black arrows). Despite the size of the valve, it has a smooth contour. Note the barium in the terminal ileum (white arrow). The valve appeared normal at colonoscopy.

View larger version (102K): [in a new window]   Figure 3. Normal-appearing ileocecal valve. Close-up view of an overhead image from a double-contrast barium enema examination with the patient in the right lateral decubitus position shows an unusually small ovoid ileocecal valve (open arrow). Note the barium in the terminal ileum (solid arrow). The valve appeared normal at colonoscopy.

View larger version (117K): [in a new window]   Figure 4. Normal-appearing ileocecal valve. Close-up view of an overhead image from a double-contrast barium enema examination with the patient in the right lateral decubitus position shows a triangular ileocecal valve (small arrows) with reflux of barium into the terminal ileum (large arrow). The valve appeared normal at colonoscopy.

View larger version (104K): [in a new window]   Figure 5. Normal-appearing ileocecal valve. Spot radiograph from a double-contrast barium enema examination with the patient in the supine oblique position shows a lateral ileocecal valve (black arrows) with stellate folds radiating toward the center of the valve. Note the barium in the terminal ileum (white arrow). The valve appeared normal at colonoscopy.

View larger version (109K): [in a new window]   Figure 6. Normal-appearing ileocecal valve. Spot radiograph from a double-contrast barium enema examination with the patient in the supine position shows a slitlike collection of barium (arrow) at the central orifice of the ileocecal valve. The valve appeared normal at colonoscopy.

View larger version (103K): [in a new window]   Figure 7. Normal-appearing ileocecal valve. Spot radiograph from a double-contrast barium enema examination with the patient in the supine oblique position shows a lateral ileocecal valve (straight black arrow) with lobulation (curved black arrow) of the inferior lip of the valve. Note the barium in the terminal ileum (white arrow). The valve appeared normal at colonoscopy.

View larger version (102K): [in a new window]   Figure 8. Equivocal ileocecal valve. Spot radiograph from a double-contrast barium enema examination with the patient in the supine position shows marked lobulation (black arrows) of the superior lip of the ileocecal valve. Despite this finding, the valve appeared normal at colonoscopy. Note how the barium-filled appendix (white arrow) is located on the same side of the cecum as the ileocecal valve.

View larger version (96K): [in a new window]   Figure 9. Ileocecal valve suspicious for tumor. Spot radiograph from a double-contrast barium enema examination with the patient in the supine oblique position shows a markedly enlarged, lobulated, and nodular ileocecal valve (black arrows). These findings were highly suggestive of malignant tumor involving the valve. Endoscopic biopsy findings confirmed the presence of adenocarcinoma of the ileocecal valve. Note how the barium-filled appendix (white arrow) is located on the same side of the cecum as the ileocecal valve.

View larger version (106K): [in a new window]   Figure 10. Equivocal ileocecal valve. Spot radiograph from a double-contrast barium enema examination with the patient in the supine oblique position shows a lateral ileocecal valve with focal lobulation (open arrows) of the inferior lip. Note the barium in the terminal ileum (solid arrow). Endoscopic biopsy specimens showed prolapsed ileal mucosa in the cecum, which contained prominent lymphoid tissue.