‘surface map’ of appendix – a novel tool for pre-operative demonstration of appendicular location with reference to mcburney’s point using multi-detector ct.

Abstract

In this study, we evaluated the role and relevance of multidetector computed tomography (MDCT) "surface map" of the appendix in demonstrating the variations in the location of the appendicular base with reference to McBurney's point and its likely clinical implications during an open appendicectomy. This prospective study included a total of 74 patients who underwent an MDCT study of the abdomen for various clinical indications. Post-processing of the data was performed and a "surface map" of the appendicular base was reconstructed with a superimposed measurement grid. The variation in the appendicular base location with reference to McBurney's point was analyzed along the cranio-caudal and medio-lateral axes. The maximum deviation in the location of the appendicular base was +10.0 cm along the cranio-caudal axis and -4.2 cm along the medio-lateral axis. The average cranio-caudal deviation was +2.79 cm, while the average medio-lateral deviation was +0.146 cm. In the subgroup of 16 patients who had appendicular inflammation, the maximum deviation was +8.8 cm along the cranio-caudal axis and +3.0 cm along the medio-lateral axis. The average cranio-caudal deviation in this subgroup of patients was +2.77 cm; the average medio-lateral deviation was +0.77 cm. The MDCT "surface map" of the appendix is an effective tool that can convey precise information regarding appendix location to the operating surgeon. There are significant variations in the location of the appendicular base with reference to McBurney's point. These variations are more pronounced along the cranio-caudal axis than the medio-lateral axis. Accurate preoperative localization of the appendicular base with MDCT will help surgeons optimize the initial incision for an open appendicectomy, thus, minimize extension-related incision risks.