Normal appearing colonic mucosa. Pale background with prominent vascular pattern. There are well defined haustral markings.
Normal colonic mucosa. In this image, the vascular pattern is not as prominent against the pale background. This may be due to endoscopic processor color settings or effects of bowel preparation.
Normal appearing cecum. The prominent, wider fold at the 7 o’clock position is the ileocecal valve.
Here, the normal appearing ileocecal valve is positioned at the 11 o’clock position. The location of the ileocecal valve is dependent on the positioning of the scope in the colon and can appear at any location, although it frequently appears on the left portion of the screen.
Normal appearing appendiceal orifice. The appendiceal orifice appears as a slit-like opening in the blind end of the cecum.
The appendiceal orifice may also appear as a crescent-shaped orifice in the cecum.
In some patients, the appendiceal orifice can appear quite large and should not be confused with the ileocecal valve, which is never seen head-on in the cecal base. It is important to recognize this as the appendix and not attempt to advance the colonoscope further, thinking that it is the ileocecal valve. In this image, note the small “red rings” in the mucosa immediately surrounding the appendiceal orifice. These represent lymphoid hyperplasia, common in the terminal ileum and cecum, and are considered a normal variant.
Fluid frequently pools at the appendiceal orifice, possibly obscuring it. Suctioning of the fluid may be required in order to identify the orifice. Likewise, changing the patient’s position (e.g., supine to left side) may shift the fluid and reveal the appendiceal orifice.