To the Editor.—The article "Ileocecal Valve Replacement: Its Effect on Transit Time, Survival, and Weight Change After Massive Intestinal Resection" by Careskey et al (Archives 1981;116:618-622) emphasized the importance of this structure. This is often forgotten during colonic resection procedures, even when retention of the ileocecal junction is possible.
Lack of appreciation of this structure may be due to the continued portrayal in anatomy textbooks of the morbid states of an ineffectual "valve," with upper and lower lips, instead of the living form, which closely resembles the cervix projecting into the vagina. Radiologists further add to the misconception: their use of a rapid inflow of 100 cm of barium, instead of the in vivo pressure of 30 cm of water, shows an ineffective ileocecal "valve" that refluxes barium well up into the small intestine. The fact is that in cases of distal colonic obstruction the ileocecal junction may hold