CAECUM

From Big Medical Encyclopedia

CAECUM [caecum (PNA); intestinum caecum (JNA, BNA)] — the initial widest part of a large intestine located from top to bottom from the place of a confluence of an ileal gut in thick. Border between S. to. and the ascending colon conditionally consider the plane passing perpendicularly to a longitudinal axis of a large intestine in the place of falling into it of an ileal gut.

Anatomy

the Form, the sizes and situation C. to. considerably vary depending on age and features of development. At newborns of C. to. quite often has the funneled or cone-shaped form. Sometimes a cone-shaped form C. to. with gradation in a worm-shaped shoot remains at mature age that is anomaly of development. Newborns have S.'s length to. on average 1,5 cm, and to its dia. 1,3 — 1,7 cm. Children up to 5 years have S.'s length to. from 1,4 to 4,1 cm, and diameter — from 1,2 to 7,3 cm fluctuate. The adult has S.'s length to. reaches 3 — 8 cm, and its diameter — 4 — 7,5 cm.

At newborn S. to. is directly under a liver or at the level of an ileal crest. Further it gradually falls sh to 14-year age usually is located in the right ileal pole. At advanced age of S. to. is located below, usually at an entrance to a small pelvis; at senile age it can be located in a small basin. According to P. P. Kulik, distinguish a high position of S. to. (over an ileal crest), noted at children in 37% of cases, and at adults — in 0,8 — 11%; average situation (in an upper half of an ileal pole) — at children in 28% of cases, at adults — in 37,8%; low situation (in the lower half of an ileal pole) — at children in 13% of cases, at adults — in 61,5%.

Usually S. to. it is covered peritoneum (see) from all directions, except for the verkhnezadny site. Approximately in 5% mezoperitoneal-ny situation C. is observed to. In 7% of S. to. has the general mesentery with final department of an ileal gut in this connection it gains big mobility (caecum mobile).

the Diagrammatic representation of a caecum, final department ileal and initial department of the ascending colon (an anterior aspect, a part of a front wall of a caecum it is removed): 1 — an ileal and colonic artery; 2 — a free muscular tape of the ascending colon; 3 — the ileocecal valve which folds limit an ileocecal opening; 4 — an ileal gut; 5 — a worm-shaped shoot; 6 — an ostium appendicis vermiformis; 7 — gaustra of a caecum.

In the place of falling of an ileal gut into thick the ileocecal valve (or a bauginiyeva the gate) having important fiziol is located. value. It periodically passes contents of an ileal gut in S. to., interfering with its return receipt in a small bowel. The valve consists of two folds of a mucous membrane located almost in the horizontal plane, in the basis to-rykh there is a ring layer of unstriated muscles. These folds forming top and bottom lips of the valve limit an ileocecal opening (fig).

From a nizhnevnutrenny surface of S. to. the worm-shaped shoot departs (see. Appendix ). In the place of an otkhozh-deniye of a worm-shaped shoot there is an opening connecting it to S.'s gleam to. Sometimes this opening is covered with a fold of a mucous membrane (valvula processus vermiformis), or Gerlakh's gate.

S.'s blood supply to. it is carried out by an ileal and colonic artery (a. ileocolica) passing in retroperitoneal space near an ileocecal corner; venous outflow — through an ileal and colonic vein (v. ileocolica) falling into an upper mesenteric vein. Outflow of a lymph happens in front and back cecal limf, nodes, further in ileal and colonic limf, nodes of an ileocecal corner. S.'s innervation to. it is carried out from an upper mesenteric texture by branches of the nerves going on the course of blood vessels.

Comparative anatomy, embryology, histology and physiology — see. Intestines .

Methods of inspection

by the Main method of a physical research C. to. the palpation is, the cut in the right ileal area normal decides on the help mobile elastic painless education, semi-oval or oblong shape, 6 — 7 cm wide. From tool methods leaders are a X-ray and endoscopic inspection (see. Irrigoskopiya , Kolonoskopiya ). At a contrast rentgenol. a research the form, an arrangement and S.'s smeshchayemost decide on administration of fixed white by means of an enema or through a mouth to., existence of deformations, narrowings, defects of filling, evakuatorny function and condition of the ileocecal valve. The endoscopic research allows to specify character patol. process to find a tumor, fistulas, to make a biopsy, to remove foreign bodys, polyps, etc.

Pathology

Pathology of a caecum includes defects of its development, damage, a disease and tumor.

Malformations caecum in the isolated look meet seldom. They are shown by increase in the sizes (typhlomegaly), formation of diverticulums, change of its form or fixing. At excessive mobility of S. to. (caecum mobile) is possible its torsion (see. Impassability of intestines ). Inborn diverticulums, as well as diverticulums of other departments of intestines (see), can be the cause of stagnation of intestinal contents (see. Locks ), educations fecal stones (see), perforation and bleeding (see. Gastrointestinal bleeding).

Damages of a caecum can be closed and opened. During the opening of a gleam of a gut develops in an abdominal cavity peritonitis (see). Treatment of such damages only operational (sewing up of defect of a wall of S. to., and at extensive gaps — a right-hand hemicolectomy). At injuries without through damage of a wall of a gut holding conservative actions is possible (rest, a sparing diet, cold on a stomach).

Functional diseases — see. Intestines .

Inflammatory diseases. S.'s inflammation to. — typhlitis (see) is considered as one of forms of segmented colitis. S.'s involvement is possible to. in inflammatory process at a disease Krone (see. Krone disease ), ulcer nonspecific colitis (see) and other forms colitis (see). Other reason of a nonspecific inflammation of S. to. can be acute appendicitis (see), at Krom inflammatory changes on S.'s walls to. extend or from a mucous membrane, or from a serous cover of a worm-shaped shoot. Also other ways of spread of an infection, napr, hematogenous are possible. Infiltration of a wall of a gut in nek-ry cases is followed by formation of single or multiple abscesses with the subsequent cicatricial granulating changes reminding a new growth. As a rule, such inflammatory pseudoneoplasms of S. to. proceed with the phenomena paracolitis (see).

S.'s tuberculosis to. makes apprx. 90% of cases of all tubercular damages of a large intestine. It proceeds in an ulcer or opukholepodobny form. In all cases the wall of a gut is deformed, its gleam is narrowed, and the inflammatory process arising around quickly leads to S.'s immovability to., what reminds a malignant tumor. The wedge, a picture is characterized by gradually amplifying pains and disturbance of a chair, emergence of blood and slime in Calais that creates a bigger looking alike clinic of cancer of S. to.

At differential diagnosis these biopsies have crucial importance. Treatment specific (see Tuberculosis extra pulmonary), and at its inefficiency — bowel resection and continuation of specific treatment after operation.

S.'s actinomycosis to. it is shown hron. inflammatory process with formation of outside fistulas (see. Intestinal fistulas), from to-rykh the pus containing druses of actinomycetes is emitted a curdled look (see. Actinomycosis ).

S.'s syphilis to. meets extremely seldom. It is revealed on the basis of data kolonoskopiya (see) with a biopsy, results of serological tests (see. Intestines , Syphilis ).

Tumors are the most frequent patol. process in S. to. Polyps meet (see. Polyp, polyposes ), fleecy tumor (see), lipoma (see) and fibromas (see. Fibroma ). Treatment is operational, including by means of the endoscopic equipment. S.'s cancer to. among malignant new growths of a large intestine takes the third place after cancer of direct and sigmoid guts. Clinic, diagnosis and treatment — see. Intestines, tumors .


Operations — see. Hemicolectomy , Intestines , Intestinal fistulas , Cecostomy .



Bibliography: Andronesku A. Anatomy of the child, the lane from Romanians., Bucharest, 1970; In and l to e r F. I. Development of bodies in the person after the birth, M., 1951; Gevorkyan I. X. and M and r z and And in joint stock company I am G. L N. Mobile caecum, M., 1969, bibliogr.; Diagnosis and cancer therapy colonic and a rectum, under the editorship of H. N. Blochina, M., 1981; And about and to them and with K. D. Bolezn of the mobile blind and ascending colonic guts, Kiev, 1980; Kiselyov A. G. About pseudoneoplasms of a caecum, Owls. hir., t. 1, No. 3-5, page 448, 1931; P. P's Sandpiper. Ana-tomo-topographical features of a caecum and their clinical value, Saturday. nauch. works Vinnitsk. state. medical in-that, t. 9, page 183, 1957; Red A. N. The atlas of operations on direct and thick guts, M., 1968; Diseases of the colon and ano-rectum, ed. by R. Turell, v. 1 — 2, Philadelphia a. o., 1969; G about 1 i g h e r J. C. Surgery of the anus, rectum and colon, L., 1975.


T. I. Vorobyov; V. I. Kozlov (An.).

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