June 1988


Author Affiliations

Riverside, Calif

Arch Surg. 1988;123(6):782. doi:10.1001/archsurg.1988.01400300128026

To the Editor.—The study by O'Connell and Kelly1 that appeared in the September 1987 issue of the Archives was somewhat strictured by dealing with the ileum without mentioning the terminal portion, which may be important in regulating function. It would be interesting to include in a series the entire ileocecal junction minus the colonic mucosa in the ileostomy, in effect, an ileocecostomy. The ileal mucosa extends to within 1 cm of the apex of the ileocecal junction, then a transitional mucosa extends to the apex, where the colonic mucosa commences (unpublished observation, L. B., Paul Boynton, MD [pathologist], 1986). Specific absorptive capacity is attributed to this terminal mucosa. Motility control commences 25 cm from the junction, where the stream is slowed (area of prune pit obstruction). The ileocecal junction picks up cecal muscle as well as ileal muscle and forms a sphincter dilator complex that surrounds an ampulla

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