Luminal and Extraluminal Factors in Normal and Pathological Appendix- A Cadaveric Study from Central Kerala, India

Abstract

Introduction: Appendicitis is the most common clinical entity among the acute abdominal emergencies. Variations in the position of appendix along with degree of inflammation makes the clinical presentation of the condition notoriously inconsistent. Anatomical knowledge about the organ is thereby mandatory for the clinical assessment and to make a confident diagnosis. Obstructive causes have been found to be responsible in 50-80% cases of acute appendicitis. The way in which the inflammatory process proceeds, still remains a topic of debate. Aim: To study the luminal and extraluminal factors in both normal and pathological appendices. Materials and Methods: This was a cross-sectional descriptive study on gross morphological parameters like frequency of various positions, blood supply of appendix, length of appendix and mesoappendix, gross luminal content conducted on 50 normal and 53 pathological appendices collected from the Departments of Forensic Medicine, Anatomy and Pathology in the Government Medical College, Kottayam, Kerala, India, for a period of one year from April 2013-March 2014. Data entered in the excel sheet was further analysed using Statistical Package for Social Sciences (SPSS) software. Continuous variables were summarised as mean and Standard Deviation (SD) and the significance between their mean variables were analysed using t-test. Results: The most common age group presenting with appendicitis was 15-30 years with male incidence more than female. Appendices were supplied by single artery in 64% and by dual arteries in 36% samples. The average length of normal appendix was 7.8±2.33 cm and pathological appendix was 6.05±1.83 cm. Total 34 (77%) of normal appendices and 9 (81.81%) of pathological appendices showed shortening in length of mesoappendix from the tip of appendix. Common positions in normal and pathological appendices were retrocaecal and pelvic respectively. The most common complication presented in this study was perforation (n=7). Appendices were fixed in 16 (32%) of normal and 12 (22.6%) of pathological appendices. Fixity and complication were commonly associated with retrocaecal position. Conclusion: Appendicitis was more common among the younger age groups. The positions of appendix had no role in initiating the appendicitis. But fixity in particular position played an important role in late presentation thereby favouring complications.