الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Colorectal cancer is the most frequent cause of large bowel obstruction, representing for more than 60% of all cases. The most serious risk associated with obstructive colon cancer is perforation, which can occur either at the site of the tumor or diastatic as a result of distension.
Evaluation of the condition of the ileocecal valve is clinically significant because an incontinent ileocecal valve permits the decompression of intestinal contents into the small intestine, whereas the maintenance of the continence mechanism produces a condition similar to a closed loop obstruction, with an increased risk of large bowel perforation.
Multidetector computed tomography (MDCT) is the most widely available, easily accessible, and comprehensive imaging technique in emergency situations. It is also the examination of choice for obstructive colon cancer because it provides both positive and severity diagnoses and has a substantial impact on the management of the disease.
The aim of this study was to assess the role of Multidetector computed tomography (MDCT) Colonography in assessing the impact of continent ileocecal valve upon severity of large bowel obstruction due to colon cancer.
The study included 53 patients who presented to the emergency department with symptoms and signs of acute obstruction. The CT scan results revealed that each of these patients had obstructive colon cancer. The age of patients ranged from 35 to 77 years, with a mean age of 55.9 years old.
Every patient was given a comprehensive medical history as well as a physical examination. A patient’s abdominal and pelvic regions were scanned with MDCT using intravenous contrast media injected at a rate of three to five millilitres per second. After the image analysis was complete, the patients were divided into two groups based on the condition of the ileocecal valve.
An incontinent ileocecal valve was defined by colonic dilatation of more than 6 cm and the distal ileal bowel loops measuring 25 mm or more.
Continent ileocecal valve was defined by a colonic dilatation of more than 6 cm and the cecum measured 8–9 cm with empty distal ileal bowel loops (provided there was no perforation).).
(CT severity signs) used as a variable were taken from the literature and analysed as follows for each patient:
• Diameter of the cecum, measured at its widest point.
• Free pneumoperitoneum.
• Defects in the bowel lining.
• Abscess.
• Lack of contrast-enhanced enhancement of the large intestine wall.
• Intestinal pneumatosis.
• Ascites.
Among the 53 patients included, 40 had an incontinent ileocecal valve and 13 had a continent ileocecal valve.
The mean cecal diameter in patients with a continent ileocecal valve was found to be statistically significantly higher; 10.2 cm compared to 8.3 cm in the incontinent cases (P value = 0.004).
After excluding cases of free pneumoperitoneum, the cecal diameter was analysed to establish a risk threshold for perforation. On the ROC curve, 10.5 cm was the cutoff point with an AUC of 0.77, 55% sensitivity and 90% specificity, 95% CI (0.599-0.954).
Free pneumoperitoneum was statistically higher in patients with continent ileocecal valve.
Abscess formation, lack of contrast enhancement, intestinal pneumatosis, and bowel wall defects exhibited no statistically significant differences.
There was no statistically significant difference between the two groups regarding the presence or absence of ascites. However in assessing the amount of ascites mild collection was statistically significant in patients with continent ileocecal valve and minimal collection was statistically significant in patients with incontinent ileocecal valve, which was attributed to a tumour reaction.
Using univariate and multivariate logistic regression analysis for all variables, it was determined that the cecal diameter was the most significant independent factor in patients with a high perforation risk.