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Background <p>Large bowel perforation represents the most severe potential complication of obstructive colorectal cancer, which might be either local or diastatic consequent to the colonic dilatation. This work aimed to evaluate the role of computed tomography (CT) in assessing the impact of ileocecal valve (ICV) continence upon the severity of large bowel obstruction due to colorectal cancer.</p> Results <p>This prospective study was conducted on 53 patients aged from 35 to 77 years old with symptoms and signs of bowel obstruction; CT findings revealed large bowel obstruction due to colon cancer (colonic diameter more than 6cm; provided there is no perforation). Among the 53 cases, 13 cases were categorized as having a continent ICV and were placed in Group 1, while 40 cases had an incontinent ICV and were placed in Group 2. CT severity signs were assessed along with surgical feedback. Free pneumoperitoneum and greater cecal diameter were statistically correlated with continent ICV, as opposed to cases of incontinent ICV. The cecal diameter was analyzed to identify a cutoff value that would differentiate between low and high perforation risk (after excluding cases of free pneumoperitoneum). The receiver operating characteristic curve revealed 10.5 cm as the cut point, with an area under the curve of 0.776. The sensitivity is 55%, and the specificity is 90%. Confidence interval is 95% (0.599–0.954).</p> Conclusions <p>To estimate the risk of obstructive colorectal cancer, the CT report should include the characteristics of the ileocecal valve and the diameter of the cecum. A continent ICV should still be regarded as a risk factor for large bowel perforation and worsening of the patient's clinical condition.</p>

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Multidetector computed tomography in assessing impact of ileocecal valve continence upon severity of large bowel obstruction due to colorectal cancer

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  • 发表日期：

    2025年7月16日

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  • Marwa Abd El-Aziz Zaghloul,
  • Ashraf Naguib Ettaby,
  • Doaa M. Emara,
  • Ahmed Osama Abd El Zaher,
  • Omnia Ezz Eldin

摘要

Background

Large bowel perforation represents the most severe potential complication of obstructive colorectal cancer, which might be either local or diastatic consequent to the colonic dilatation. This work aimed to evaluate the role of computed tomography (CT) in assessing the impact of ileocecal valve (ICV) continence upon the severity of large bowel obstruction due to colorectal cancer.

Results

This prospective study was conducted on 53 patients aged from 35 to 77 years old with symptoms and signs of bowel obstruction; CT findings revealed large bowel obstruction due to colon cancer (colonic diameter more than 6cm; provided there is no perforation). Among the 53 cases, 13 cases were categorized as having a continent ICV and were placed in Group 1, while 40 cases had an incontinent ICV and were placed in Group 2. CT severity signs were assessed along with surgical feedback. Free pneumoperitoneum and greater cecal diameter were statistically correlated with continent ICV, as opposed to cases of incontinent ICV. The cecal diameter was analyzed to identify a cutoff value that would differentiate between low and high perforation risk (after excluding cases of free pneumoperitoneum). The receiver operating characteristic curve revealed 10.5 cm as the cut point, with an area under the curve of 0.776. The sensitivity is 55%, and the specificity is 90%. Confidence interval is 95% (0.599–0.954).

Conclusions

To estimate the risk of obstructive colorectal cancer, the CT report should include the characteristics of the ileocecal valve and the diameter of the cecum. A continent ICV should still be regarded as a risk factor for large bowel perforation and worsening of the patient's clinical condition.