Ileocaecal Valve

[leithcote]

After reading a number of posts here in the Surgical Forum, I am quite interested to know what experiences people have had after surgery - where their ileocaecal valve (ICV) has been removed.

My (fantastic) surgeon pointed out the the ICV is a curious thing. In some, it seems to be very important, controlling the flow of material from the small bowel into the large (and stopping it going back again! - see post below)

Saying that, for others, its removal is well tolerated, and seems to cause no gross long term side effects.

As someone who has recently has surgery, and no longer has an ICV, I seem to be in the latter category - and so far I am not missing it in the least.

My Crohn's has never really presented with diarrhoea (chronic or otherwise), so I am wondering...

A) before your surgery did you have problems with diarrhoea?

B) after surgery and losing your ICV, did you *then* starting having problems with loose stools?

C) are you like me, with minimal, if any diarrhoea issues after ICV removal?

With regards, Tony.

 

[archie]

Tony i'm the same as you on all accounts, I never really suffered diarrhea pre surgery, I very occasionally suffer from it now but in general I am in fact more constipated and I haven't really suffered any other side effects from not having it. I do think the constipation could be due to sluggish bowels now and possibly mild inflammation at surgery site but I have no active crohns. I do get strong cramps pre poo so I'm just keeping a wee eye on things in case it is the start of a stricture due to adhesions. All in all i'm pretty normal though, although my hubby might disagree

 

[leithcote]

I just wanted include this useful information from David, with regards to the role of the ileocaecal valve - and some more possible complications when it is removed.

Tony, the valve also helps prevent reflux of fecal matter and bacteria from the large to small intestine. SIBO is somewhat common in people who have had it removed. In addition, there's the matter of bile acid absorption which of course also relates to enterohepatic circulation. Removal also results in decreased fluid and nutrient absorption.

 

[leithcote]

Archie - thanks for the post and the useful info. I'm not imagining for one minute that I'm not going to have some diarrhoea / bowel issues in the future, but like you, if anything I'm slightly more constipated than (what I can remember as being) normal! It's still too early I guess, for me, to find out about any B12 and bile salt absorption issues. Touch wood!

 

[archie]

touch wood my b12 levels are normal last count 360 ish although david would prob say this is still low, i was taking suppliments before xmas (1000ng) oral tabs and it was 860 and then i stopped and obviously it has dropped. Again i'll keep an eye on things, do u know the symptoms of SIBO?? My constipation has become a bit worse and i needed to take movicol but again it didn't really help then I had a wee night out with lots of vino and that did the trick!!! but in all seriousness I do feel pretty normal on a day to day basis i occasionally get symptoms of IBS now which I didn't have before.

 

[DustyKat]

Hey Tony,

Both of my children have had right hemicolectomies. My daughter had a far more extensive one (70cm) than my son (28cm) but both had issues with bile salt malabsorption diarrhoea post op.

A) before your surgery did you have problems with diarrhoea?

Neither had diarrhoea pre surgery.

B) after surgery and losing your ICV, did you *then* starting having problems with loose stools?

Yes, both did and it was immediate with Sarah being worse than Matt.

C) are you like me, with minimal, if any diarrhoea issues after ICV removal?

Both use psyllium to control it. Sarah is nearly 6 years post op now and now only goes once a day and it is solid. I think it is a combination of psyllium, diet and perhaps the bowel over time starting to take some of the salts up again???


Due to the amount of bowel Sarah had removed it was a given, regardless of levels, that she would require B12 injections. Matt's more conservative op means we are keeping an eye on them but I wouldn't be surprised if he too needs them at some point.

Dusty. xxx