Retrocaecal Position Research Articles

Position and Length of Appendix among Delhi Population-An Autopsy Based Study

Vermiform appendix reportedly shows lots of variations in its position and length among different individuals. The signs and symptoms presented by acute appendicitis requiring medical or surgical intervention may vary accordingly. Hence, medical practitioners should have a fair knowledge of such variations to diagnose the underlying pathology. Knowledge about variations in the position and length of the appendix is also equally important for its removal through minimally invasive surgery. The present study was conducted at Lady Hardinge Medical College, New Delhi from October 2018 to March 2020 to observe the variations in position and length of appendix in the dead bodies brought for routine medico-legal autopsies. Among 200 randomly selected deceased individuals, males were 88.5% whereas females were 11.5%. Maximum numbers of individuals were found in the age group 31–40 years (23%), followed by 41–50 years (22.5%) and then 21–30 years (22%). The mean age of the individuals was 43 ± 14.98 years, with an age range varied from 14 to 90 years. Position of the appendix was found pre-ileal in 6.5%, post-ileal in 10%, promonteric in 12%, pelvic in 21%, retro-caecal in 27.5%, para-colic in 13.5%, sub-caecal in 6.5% and others in 3% cases. Retro-caecal position was the most common position in the present study. The mean length of the vermiform appendix was found to be in the range of 0–5 cm in 10.5%, 5–10 cm in 63%, 10–15. cm in 21.5%, 15–20 cm in 4.5%, and more than 20 cm in 0.5% cases. The mean (average) length of the vermiform appendix was 8.4 ± 3.07 cm, with a range varied from 4.2 cm to 21.1 cm. The position of the appendix could not be related to the sex and age of the individual or to the length of the appendix.

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

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.

Acute appendicitis as the cause of non-traumatic acute abdomen in a tertiary care hospital: A retrospective study

Background: In our era of improved care at primary and secondary health care centres, we wanted to study the epidemology and clinicoradilogical presentation of acute appendicitis in our tertiary care centre.Materials and Method: The age and sex incidence, position of appendix, radiological corelation with clinical diagnosis were analysed retrospectively of 132 cases of acute appendicitis out of 200 cases of acute abdomen which were treated surgically in department of general surgery Trichy SRM medical college, from October 2018 to October 2019.Results: Highest incidence of appendicitis was 61 cases (46.21 %) were in the 21-30years age group, among 32 cases 88 cases (66.67%) were male and 44 cases (34.09%) were female, Retrocaecal position was 68.18% and 95% of times radiological corelation was positive or acute appendicitis. Conclusion: Our study showed highest incidence of acute appendicitis in the age group of 21-30 yrs with male preponderance. Most common position of tip of appendix was retrocaecal and radiological corelation of diagnosis of acute appendicitis was 95%.

WITHDRAWN: An interesting case of retrocaecal internal herniation causing small bowel obstruction

Herein, we report a case of an elderly woman with multiple co-morbidities who presented with clinical findings indicative of small bowel obstruction (SBO), which was confirmed on a CT scan. She underwent a laparotomy, which demonstrated herniation of small bowel into a retrocaecal position. Gangrenous small bowel was resected and primary anastomosis performed. After a brief period on the High Dependency Unit (HDU), she returned to the ward and was discharged back to the community.

Lengths and Positions of the Vermiform Appendix among Sudanese Cadavers

Background/objective: The anatomy of vermiform appendix displays great variations in length and position between different populations. The reports relating these variations to a specific etiological factor are few. This study aims to describe the positions and lengths of vermiform appendix among Sudanese cadavers. Methods: This descriptive study was carried out in Omdurman Teaching Hospital Morgue and Omdurman Islamic University-Sudan. Sixty Sudanese cadavers (30 male and 30 female), were dissected in the period from June 2013 to June 2014. The positions and the lengths of vermiform appendix were measured in millimeters. The data was analyzed by SPSS version 20. Results: The cadavers’ age ranged between 20 to 80 years according to their medico-legal reports. Retrocaecal position was mainly observed in 60%, pelvic in 35%, post-ileal in 3.3%, and pre-ileal in 1.7%. The lengths of the appendix was found 110 mm in 16.7%, also the study showed insignificant difference between the lengths and ages (p < 0.08), and between males and females (p = 0.23). Age was the influencing factor for the positions of vermiform appendixes (p = 0.04). Conclusion: The study showed that the commonest lengths of the appendix were 70-110 mm while the common position was retrocaecal regardless to age or gender. This data should be considered in surgical removal of the inflamed appendix.

English

Introduction Blunt abdominal trauma (BAT) leading to appendicitis is rare. This can be challenging for diagnosis. The aim of this study was to investigate appendicitis occurring after BAT. Materials and methods A three-year study was performed to investigate appendicitis developing after BAT. Results A total of 8 patients were studied. All had isolated post-traumatic appendicitis without any other associated abdominal injury. Retrocaecal position was observed in all; one patient had perforated appendicitis and one had an appendicular lump. Fecalith was present in 5 patients. Grossly, all patients had characteristics of appendicitis. Conclusion BAT leading to appendicitis is rare. Retrocaecal position of the appendix is commonly affected.

Morphological Variations in the Anatomy of Caecum and Appendix - A Cadaveric Study

Abstract Background : Appendicitis is one of the most common clinical conditions that require emergency surgery. Variations in anatomical location of appendix can result in different clinical presentations. Anatomical and topographical variations of the caecum are also known to occur. Anatomical variations in caecum have been observed along with the appendix in this study. Aims: To study the variations in the size, shape, position and arterial supply of the caecum and appendix in individuals of different sex and age, a thorough knowledge of which will aid surgeons in performing various abdominal operations in adults and children. Material and methods: The study was carried out on 25 adult cadavers over a period of 3 years. The anatomy of caecum and appendix was studied in detail. Results : The normal position of caecum and appendix in adult cadavers was found to be in the right iliac fossa. In all specimens the shape of caecum was adult (ampullary) type and it was supplied normally in all cases from a branch of the superior mesenteric artery. The appendix was found in the retro-caecal position in majority of cases with a complete meso-appendix in four and an additional blood supply via the artery of Sesachalam was found in two cases. Conclusions: Vermiform appendix is characterized by variability of its location and morphology. The ultimate position of the appendix is influenced by the changes in position and shape which the caecum undergoes during development and growth. The present study observed the appendix and caecum to be found in their normal positions in majority of cases. The average length of caecum and appendix was found to be more in males as compared with females. Appendicitis is one of the most common diseases that need emergency surgery. Variations in anatomical position cause different clinical presentations. A thorough knowledge of normal anatomy and variations of the caecum and appendix is very important to the surgeon performing abdominal operations in adults, children and infants as it helps them to make optimal diagnosis of various pathological conditions related to these organs and treat accordingly.

Morphological variations in the anatomy of caecum and appendix - A cadaveric study

Background : Appendicitis is one of the most common clinical conditions that require emergency surgery. Variations in anatomical location of appendix can result in different clinical presentations. Anatomical and topographical variations of the caecum are also known to occur. Anatomical variations in caecum have been observed along with the appendix in this study. Aims: To study the variations in the size, shape, position and arterial supply of the caecum and appendix in individuals of different sex and age, a thorough knowledge of which will aid surgeons in performing various abdominal operations in adults and children. Material and methods: The study was carried out on 25 adult cadavers over a period of 3 years. The anatomy of caecum and appendix was studied in detail. Results : The normal position of caecum and appendix in adult cadavers was found to be in the right iliac fossa. In all specimens the shape of caecum was adult (ampullary) type and it was supplied normally in all cases from a branch of the superior mesenteric artery. The appendix was found in the retro-caecal position in majority of cases with a complete meso-appendix in four and an additional blood supply via the artery of Sesachalam was found in two cases. Conclusions: Vermiform appendix is characterized by variability of its location and morphology. The ultimate position of the appendix is influenced by the changes in position and shape which the caecum undergoes during development and growth. The present study observed the appendix and caecum to be found in their normal positions in majority of cases. The average length of caecum and appendix was foundto be more in males as compared with females. Appendicitis is one of the most common diseases that need emergency surgery. Variations in anatomical position cause different clinical presentations. A thorough knowledge of normal anatomy and variations of the caecum and appendix is very important to the surgeon performing abdominal operations in adults, children and infants as it helps them to make optimal diagnosis of various pathological conditions related to these organs and treat accordingly.

Retrocaecal Appendix Position and #8211; Findings During the Clasic Appendectomy

Appendicitis is one of the most common diseases that require urgent surgical intervention. Due to its position, the inflamed appendix can cause many complications in abdominal cavity. Most of these complications are based on the anatomical position of the appendix. According to world literature over 65% of the anatomical positions of appendix is retrocaecal position, followed paracaecal and then the other positions of the appendix in different percentages. The main goal of this research is to shown that anatomical retrocaecal position of the appendix can lead to prolonged hospitalization and more often occurrence of appendicitis complications. The research is based on patients who had appendectomy during 2009 at the Cantonal Hospital Zenica and General Hospital Tesanj. The study included approximately 400 respondents and the method of research was of retrospective, descriptive and analytical type. According to the results of this research we can conclude that in our country is not devoted enough attention to the anatomic position of the appendix and that we are not using enough diagnostic methods such as ultrasound and CT in determining the anatomic position to help determine the course of the disease. Retrocaecal appendix position according to the obtained data from this study did not cause many complications in classical appendectomy but this can be attributed to insufficient observation of the anatomical position of the appendix.

Position and susceptibility to inflammation of vermiform appendix in Accra, Ghana

To determine the normal (non-inflamed) position of the vermiform appendix in Ghana and carry out a pilot study to test the hypothesis "The retrocaecal appendix is less prone to inflammation". Retrospective autopsy study. The pathology department and the department of surgery theatres of the Korle Bu Teaching hospital in Accra, Ghana Consecutive autopsies and inflamed appendices at appendicectomy. Deaths occurring from untreated appendicitis were excluded from the autopsy study. Conversely non-inflamed appendices and appendices from interval appendicectomy were excluded from the appendicitis study. There were 1358 autopsies and 323 inflamed appendices. In the autopsy study the retrocaecal position was the most common (914 [67.3%]). Other positions were pelvic (294 [21.6%]), preileal (66 [4.9%]), postileal (51 [3.8%]) and paracaecal (33 [2.4%]). These positions were similar in males and females. The positions of 323 inflamed appendices were: retrocaecal (183 [56.7%]), pelvic (66 [20.4%]), preileal (20 [6.2%]), postileal (15 [4.6%]) and paracaecal (39 [12.1%]). Comparing the nonretrocaecal to the retrocaecal position by chi square, the non-retrocaecal position was more prone to inflammation (p<0.001). The position of the normal appendix in Ghana differs from Western literature. The retrocaecal position appears less prone to inflammation in Ghanaians.

Was bringt die Ultraschalluntersuchung der akuten Appendizitis (bei dosierter Kompression)?

The value of ultrasound in diagnosing acute appendicitis has been examined in a prospective study of 103 patients. Only those patients with an uncertain diagnosis of acute appendicitis were included in the study. We used a 5 or 7.5 MHz linear array transducer applying graded compression. An acutely inflammatory appendix appeared as a tubular structure with a diameter of 3 to 12 mm. The sensitivity of the examination in our material was 82%, the specificity 97%. The main reason for the relatively low sensitivity were cases with a retrocaecal position of the appendix. Ultrasound can be recommended as a highly specific but less sensitive imaging method for the diagnosis of acute appendicitis in clinically equivocal cases.

The position of the vermiform appendix at laparoscopy

The vermiform appendix has no constant position and the data on the variations in its position are limited. The aim of this study was to determine the frequency of the various positions of the appendix at laparoscopy. Patients undergoing emergency or elective laparoscopy at a university teaching hospital between April and September 2004 were studied prospectively. The positions of the appendix and the caecum were determined after insertion of the laparoscope, prior to any other procedure and the relative frequencies calculated. A total of 303 (102 males and 201 females) patients with a median age of 52 years (range 18-93 years) were studied. An emergency appendicectomy was performed in 67 patients, 49 had a diagnostic laparoscopy, 179 underwent a laparoscopic cholecystectomy and eight had other procedures. The caecum was at McBurney's point in 245 (80.9%) patients, pelvic in 45 (14.9%) and high lying in 13 (4.3%). The appendix was pelvic in 155 (51.2%) patients, pre-ileal in 9 (3.0%), para-caecal in 11 (3.6%), post-ileal in 67 (22.1%) and retrocaecal in 61 (20.1%) patients. Contrary to the common belief the appendix is more often found in the pelvic rather than the retrocaecal position. There is also considerable variation in the position of the caecum.

Acute Appendicitis In Identical Twins

Simultaneous cases of appendicitis in identical twins are extremely rare. We report identical twins who presented with similar features of appendicitis within 5 days of each other. CASE HISTORIES CASE 1 The first patient was a 14 year old girl from South African origin who presented with a 36 hour history of central abdominal pain which later localised to the right iliac fossa. There was no significant past medical history. Clinical examination revealed a temperature of 38°C, with local peritonism in the right iliac fossa. Labarotory investigations did not reveal leucocytosis. The patient underwent a routine appendicectomy without any complications. The appendix was mildly inflamed, confirmed on histology, in a retrocaecal position. She was later discharged on the second post-operative day. CASE 2 The identical twin of the first patient presented five days after her sister with a 24 hour history of right iliac fossa pain. Her past medical history was unremarkable. On examination, she had a temperature of 37.8°C and was tender in the right iliac fossa. Her blood results were also normal without any evidence of leucocytosis. The patient underwent an uncomplicated appendicectomy through a lanz incision. The appendix was inflamed in a retrocaecal position. Histology confirmed the diagnosis. She made an excellent post operative recovery and was discharged on the second post-operative day. DISCUSSION Simultaneous cases of acute appendicitis are extremely rare and only five cases have been reported in the literature.1,2,3,4,5 Genetic factors have been implicated by some authors. Basta et al. performed a retrospective analysis of the families of 80 patients with acute appendicitis. They showed familial aggregation and polygenic transmission when compared to similar ‘control' families.5 All of the twins evaluated in the literature presented in the first or second decade within a day of each other. Appendicitis was also confirmed on histology. Although the South African twins presented slightly further apart, it is interesting that both were pyrexial and did not show leucocytosis. Furthermore, both had their appendix in the retrocaecal position. There are not sufficient cases in the literature to conclude whether genetics or coincidence is responsible for this presentation. However, one would imagine that there would be more reported cases of simultaneous appendicitis amongst identical twins given the 1 in 300 chance of twin pregnancy. CORRESPONDENCE TO Amyn Haji MA MBBChir MRCS(Lon) MRCS(Ed), Specialist Registrar, South East Thames Rotation Kings College Hospital, Denmark Hill, London SE5 9RS Tel. 07970292532 Fax. 02086911060 Email: amynhaji113@aol.com

Extent of Mesoappendix of Vermiform Appendix in Bangladeshi People

Background: The mesentery of the appendix extends almost to the appendicular tip along the whole tube or may not be to the tip. The mesoappendix has a free border which carries the blood supply to the organ. Failure of the mesoappendix to reach the tip probably reduces the vascularization of the tip of the organ making it more liable to become gangrenous and hence early perforation occurs during inflammation. Objective: This cross sectional study was carried out to advance our knowledge regarding the extent of mesoappendix in Bangladeshi people and also to find out the variations in the anatomical positions of the vermiform appendix in Bangladeshi population and their distribution according to the sex. Methods: A total of 100 (60 male and 40 female) specimens of vermiform appendix were collected of different age and sex during postmortem examination in the morgue of Mymensingh Medical College from July 2006 to June 2007. Data was collected by convenient sampling technique. Results: In this study pelvic position of the vermiform appendix were common in both sexes. The two thirds extension of mesoappendix was found in 45% cases where as in pelvic position it was 26 (14 male and 12 female) cases. Half and whole extension of mesoappendix were found in 31% and 24% cases respectively. Among half extension of mesoappendix, retrocaecal position were found to be more (12) than other positions. In whole extension of vermiform appendix pelvic position were found to be common (16) than others. Conclusion: This study provides certain basic information of extent of mesoappendix of vermiform appendix of Bangladeshi population which is responsible for vascularization of the organ and severity during inflammation. Key words: Vermiform appendix, Mesoappendix DOI: 10.3329/jbsp.v4i1.4065 J Bangladesh Soc Physiol. 2009 June; 4(1): 20-23

Position of Vermiform Appendix: A Postmortem Study

Context: Vermiform appendix is an organ with immunological function in the abdominal cavity which is variable in position and length. It is important in different disease processes, such as appendicitis, carcinoma and diverticulitis. Appendicitis is the most important clinical condition. Appropriate anatomical knowledge about vermiform appendix is important for surgeons, pathologists and other physicians for proper diagnosis and management of appendicitis and carcinoma. Study design: Descriptive type of study. Place and period of study: Department of Anatomy, Sir Salimullah Medical College Hospital, Dhaka, from January 2006 to June 2007. Materials and methods: Sixty (60) human postmortem vermiform appendix, age ranging from 0 to 65 years. Samples were observed in situ in the unclaimed dead bodies within 24 hours of death. Results: Retrocaecal position was highest (65%) followed by pelvic (31.7%) and post ileal (3.3%). Subcaecal and pre ileal varieties were not found. Conclusion: To establish a data for Bangladeshi people, future studies are necessary by using larger sample size from different age and sex groups. To determine position of vermiform appendix, sonological studies are also recommended. Key words: position, vermiform appendix doi: 10.3329/bja.v7i1.3015 Bangladesh Journal of Anatomy January 2009, Vol. 7 No. 1 pp. 34-36

Anatomical Positions of Vermiform Appendix in Bangladeshi People

The study was done to see the incidences of different anatomical positions of vermiform appendix in Bangladeshi people to increase the knowledge regarding variational anatomy in our population. A total 100 vermiform appendix (male-60, female-40) were observed in situ on cadaver of different age and sex during routine post mortem examination in the autopsy laboratory of Forensic Department of Mymensingh Medical College. This cross-sectional descriptive study was done by convenient sampling technique. For convenience of differentiating the incidences of different positions of vermiform appendix in relation to age and sex findings were classified and analyzed in four age groups (up to 20 year, 21 - 35 years, 36 - 55 years, 56 - 70 years) and in different sex. &#x0D; In the present study, the pelvic position of vermiform appendix was the most common position in all age groups and pelvic positions were found in 47% cases. The retrocaecal position was the second highest position (22%) and pre ileal position was the lowest (10%) in number. In respect to sex, incidences of pelvic variety of vermiform appendix were more in male than female. &#x0D; &#x0D; Key words: Vermiform appendix, anatomy, position &#x0D; &#x0D; J Bangladesh Soc Physiol. 2006 Dec;(1):5-9