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The fold of Treves is a fat pad, which extends over the antimesenteric side of the terminal ileum to the cecum. Its relation to the cecum is variable. In its simplest form it is a quadrilateral fold extending between the ileum and the appendix, the short side being attached to the cecum and the free edge forming the anterior boundary of the ileocecal fossa. It is usually nearly transparent and relatively avascular. This led to the term "bloodless," because the structure is strikingly devoid of vessels as compared with neighboring folds when viewed by the naked eye.1 However, some authors have noted small vessels in this fold during various abdominal operations.2
The fold of Treves has only once before been associated with a pathologic condition. In a case report published in 2008, a 30-year-old woman with acute onset of right lower quadrant pain was found to have inflammation and necrosis of the ileocecal fold of Treves and a normal-appearing appendix.3 We document a patient with yet another pathologic process involving the fold of Treves, specifically hypertrophy causing a closed loop obstruction of the terminal ileum.
A 57-year-old woman presented to the emergency department with severe epigastric pain of 3 hours duration...