The Hidden Cecal Region: Highlighted in a Clinical Case

Fujii, Takahiro

doi:10.1007/978-88-470-5205-5_7

Takahiro Fujii²

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Background

Accurate exploration of the cecal region represents a fundamental step in achieving a proficient colonoscopy and in improving the adenoma detection rate [1].

The morphology of the cecal valve or a redundant tenia coli may sometimes obscure or mimic the cecal region. Thus, the endoscopist should carefully inspect this region by locating the endoscope below the valve’s lower lip in order to reduce the rate of missed early colorectal cancers [2]. In addition, intubation of the terminal ileum has been suggested by many authors as definitive proof of a total colonoscopy [3].

An improved endoscopic view is now available with new techniques such as virtual chromoendoscopy. A magnifying view provides added value in the early detection of colorectal cancer; however, the endoscopist must keep in mind the “red flags” regarding the mucosal appearance of these tumors [4].

Laterally spreading tumors account for 5% of all polypoid and non-polypoid lesions, with a higher prevalence in the cecum and rectum; Laterally spreading tumors account for 5% of all polypoid and non-polypoid lesions, with a higher prevalence in the cecum and rectum; thus, a careful inspection of the cecal region should be mandatory [5].

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Authors and Affiliations

Clinic, Digestive Endoscopy, Tokya, Japan
Takahiro Fujii

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Takahiro Fujii
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Correspondence to Takahiro Fujii .

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Editors and Affiliations

Department of Operative Endoscopy, Usi Group, Rome, Italy
Antonello Trecca

Additional information

Multiple Choice Questionnaire

1)
What is the incidence of laterally spreading tumor, granular type among all colorectal lesions?
1. a.
  10%
2. b.
  20%
3. c.
  30%
4. d.
  5%
2)
Which is the more frequent site of a laterally spreading tumor?
1. a.
  left colon
2. b.
  rectum
3. c.
  cecum and rectum
4. d.
  sigmoid colon
3)
Which is the most frequent location of tumors with a flat-type appearance?
1. a.
  transverse colon
2. b.
  right colon
3. c.
  sigmoid colon
4. d.
  rectum
4)
Which is the most frequent location of tumors with a polypoid-type appearance?
1. a.
  transverse colon
2. b.
  right colon
3. c.
  left colon
4. d.
  rectum
5)
What are the current indications for colorectal endoscopic submucosal dissection?
1. a.
  polypoid lesions <40 mm in diameter
2. b.
  all laterally spreading tumors and non-polypoid lesions
3. c.
  laterally spreading tumors located in the rectum
4. d.
  lesions with submucosal invasion ≦1000 μm, with negative lymphovascular invasion and a well differentiated component

1. d — 2.c — 3.a — 4.c — 5.d

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Fujii, T. (2013). The Hidden Cecal Region: Highlighted in a Clinical Case. In: Trecca, A. (eds) Atlas of Ileoscopy. Springer, Milano. https://doi.org/10.1007/978-88-470-5205-5_7

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DOI: https://doi.org/10.1007/978-88-470-5205-5_7
Publisher Name: Springer, Milano
Print ISBN: 978-88-470-5204-8
Online ISBN: 978-88-470-5205-5
eBook Packages: MedicineMedicine (R0)

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