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The Mechanical Factor in Obstructive Cecal Perforation

Arch Surg. 1961;83(6):911-915. doi:10.1001/archsurg.1961.01300180111021.
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The inherent dangers of a closed-loop obstruction occurring in the large bowel are well known. The competency of the ileocecal valve is the single most important factor in the train of events that will occur subsequent to an obstructing colonic lesion. At the beginning of the 17th century, Bauhin described a sphincter between the cecum and the term nal ileum. He postulated that it acted mechanically to resist back-pressure. The presence of both circular and oblique muscle fibers indicates that the valve acts also as a true sphincter. In large-bowel obstruction, vomiting may occur late or not at all. With a competent ileocecal valve, a closed-loop obstruction results and the situation becomes most acute. The systemic symptoms may be misleading, and intestinal intubation will not alleviate the situation. The major danger is a mechanical perforation of the bowel, usually at the cecum; and because of this the condition requires immediate


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