ANATOMY OF TULP’S VALVE

Abstract

Introduction: Tulp’s valve is also known as ileocaecal valve which is situated at ileocaecal junction. Tulp’s valve is a diverse anatomical valve where the ileum makes an access into the caecum. Earlier researchers have observed that there is occurrence of high densities of neurons in the Tulp’s valve, though meticulous anatomical depiction about constitution of the myenteric plexus in and around the Tulp’s valve has thus far to be obtained in humans. In array to add contribution to this vicinity of explore, the present work was performed to appreciate the anatomical composition of myenteric plexus in and around the Tulp’s valve in human foetuses.
 Materials and Methods: The research was performed on ileocaecal sections obtained from human foetuses (n=17) of various gestational ages after obtaining ethical authorization from the ethical clearance committee of Hind Institute of Medical Sciences, Sitapur. Cresyl Violet staining and NADPH- diaphorase enzyme histochemistry was performed over the obtained ileocaecal sections. Study Group-1(G-1) included foetuses of 9 to 14 week of gestational age group while Group-2(G-2) comprised of foetuses of 15 to 33 week of gestational age group. The Neuronal cell profiles (area, perimeter, ferret diameter) and Neuronal cell density were assessed in and around the Tulp’s valve in human foetuses. 
 Results: In Cresyl violet stained sections, the difference in the neuronal cell profile area between G-1 (50.10±2.26 µm2 )and G-2 (61.25±4.07 µm2 ) was found to be statistically significant (p=0.0028).The perimeter of myenteric neuronal cells in G-1 (26.32±0.51 µm ) was significantly (p=0.0028) lower than G-2 (29.17±0.85 µm). The differences in Feret diameter of neuronal cells between G-1 (9.49±0.27 µm) and G-2 (10.53±0.21 µm) was statistically significant (p=0.0028). The neuronal cell density in Myenteric Ganglia (MG) in G-1 and G-2 was 60.01±9.77 and 52.27±6.54 respectively, which was statistically insignificant (p=0.1367) difference. The difference in the nitrergic neuronal cell area between G-1 (66.35±8.43 µm2) and G-2 (74.93±0.53 µm2) was statistically significant (p=0.0038). The mean perimeter of nitrergic neuronal cells in G-1 (32.01±2.57µm) was insignificantly (p=0.2001) lower than G-2 (33.83±0.73 µm). The mean Feret diameter of G-1 (11.97±1.26) was also insignificantly (p=0.2624) lower than G-2 (12.91±0.75). The nitrergic neuronal cell density in Myenteric Ganglia in G-1 was 22.41±4.13 and in G-2 it was 18.61±2.09, which was statistically insignificant (p=0.0983). acquaintance of the innervations of the Tulp’s valve in human foetuses may help in restoration of it for improved movement of ileum inside into the caecum, as well as to check retrospective run of caecal inside into the ileum.
 Keywords: Tulp’s Valve, Cresyl Violet, NADPH- diaphorase, Nitrergic Neurons