Abstract
Aim: Two major ways to locate the ileocecal valve (ICV) are to look for a thickening or
bulge on the ileocecal fold, and the other is the “bow and arrow” method or the “appendix
trick”. The aim of this study was to determine the accuracy of “bow and arrow” method
to locate the ICV during colonoscopy. Patients and Methods: Colonoscopy was performed with the patients in the left lateral position. After cecal
intubation had been confirmed, the appendiceal opening was identified, with the curve
serving as the bow, an imaginary arrow was placed across the curve toward the appendix
lumen. The tip of the imaginary arrow was then followed to confirm if it correlated
to the location of the ICV. Results: The “bow and arrow” accurately located the ICV in 105 (76.6%) patients, but failed
in 32 (23.4%) patients. The mean age (56.2 ± 13.1 years) of the patients in whom the
“bow and arrow” located the ICV was lower than that (62.7 ± 0.9 years) of the patients
in whom it failed to locate the ICV. Males, 58 (71.6%) had positive “bow and arrow”,
while this was observed in 47 (83.9%) females. It correctly located the ICV in 73
(53.3%) of those with thin‑lip ICV, 20 (14.6%) of those with volcanic type, and 12
(8.8%) of those with double bulge ICV. Conclusion: The bow and arrow sign could not locate the ICV in all cases in our practice and
so where it failed, alternative method should be employed to locate the ICV.
Keywords
Appendiceal orifice
-
bow and arrow
-
colonoscopy
-
ileocecal valve
