Các độ cong gan. Nó là mái vòm hình. Các đường giao nhau giữa độ cong gan và ruột kết tăng dần là luôn luôn ẩn ở góc trên bên phải của màn hình đằng sau những nếp gấp niêm mạc. Chỉ đạo trục ngược chiều, kéo nó trở lại, và độ cao của đỉnh để mở rộng lòng gấp. Sau đó theo chiều kim đồng hồ quay và độ lệch của đỉnh | 146 CHAPTER 7 Fig. The hepatic flexure. The mucosa of this area is paler and has light bluish tinge acquired from the adjacent liver. Fig. The hepatic flexure. It is dome-shaped. The junction between the hepatic flexure and the ascending colon is always hidden in the right upper corner of the screen behind the mucosal fold. Steering of the shaft counterclockwise pulling it back and elevation of the tip help to stretch the folded lumen. Subsequent clockwise rotation and deviation of the tip to the right and decompression of the colon facilitate exploration of the ascending colon. Direction to the ascending colon Fig. The appendiceal orifice. the adjacent transverse colon. It points toward the right lobe of the liver and is sharply angled posteriorly Fig. . The ascending colon is a short retroperitoneal and fixed segment of the right colon. It runs between the cecum anteriorly and the lower pole of the right kidney posteriorly. The lumen of the ascending colon is wide and constantly opened. It terminates as a blind pouch cecum which has two landmarks appendiceal orifice and ileocecal valve The appendiceal orifice is usually oval or rounded Fig. and is located at the intersection of the teniae coli. The ileocecal valve is situated at the posterior medical aspect of the cecum. It usually stays aside from the forward-oriented optical system of a colonoscope. That is why it is only partially seen as a focal widening of the circular fold Fig. . In the newborns the cecum is cone-shaped with the appendix in the middle. Later on the cecum expands sideways by unequal enlargement of the haustra a lateral sac becomes more spacious Fig. The ileocecal valve. A focal widening of the circular fold in the cecum is the sign of the hiding ileocecal valve. PEDIATRIC COLONOSCOPY 147 than the medial one. Thus the cecum assumes an eccentric shape. The thickness of the cecal wall is the smallest along the colon which should be kept in mind during .
