New insights into the neuromuscular anatomy of the ileocecal valve

Cserni, Tamás and Paran, Sri and Kanyári, Zsolt and O’Donnell, Anne-Marie and Kutasy, Balázs and Németh, Norbert and Puri, Prem (2009) New insights into the neuromuscular anatomy of the ileocecal valve. ANATOMICAL RECORD, 292 (2). pp. 254-261. ISSN 1932-8486

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Abstract

The neuroanatomy of the ileocecal valve (ICV) is poorly understood. A better understanding of this important functional component of the gastrointestinal tract would enable surgeons to reconstruct an effective valve fol- lowing surgical resection of the ICV. ICVs were examined in young pigs (N 5 5) using frontal and transverse paraffin embedded and frozen sections. Hematoxylin1Eosin (H1E) staining, acetylcholinesterase (AchE), and NADPH-diaphorase (NADPH-d) histochemistry and protein gene product 9.5 (PGP 9.5) and C-kit immunohistochemistry were performed. The H1E staining revealed that the ICV consists of three muscle layers: an external circular muscle layer continuous with that of the ileal circular muscle layer, an inner circular muscle layer continuous with that of the cecal cir- cular muscle layer, and a single longitudinal muscle layer, which appears to be secondary to a fusion of the ileal and cecal longitudinal muscle layers. The AchE, NADPH-d, and PGP 9.5 staining revealed two distinct coaxial myenteric plexuses, together with superficial and deep submucosal plexuses. The C-kit immunostaining showed a continuous myenteric ICC network within the ICV. The structure of the neuromuscular components within the ICV suggests that the valve is a result of a simple intussusception of the terminal ileum into the cecum. This knowledge may help sur- geons in their futureAQ2 attempts at reconstructing more anatomically and functionally suitable ICVs following surgical resection of native ICVs.

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