APPENDICITIS.doc - APPENDICITIS ANATOMY Definition This is...

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APPENDICITISANATOMYDefinitionThis is a worm-like diverticulum arising from theposteromedial wall, of the caecum, about 2 cm below theileocaecal orificeIt is a blind muscular tube with mucosal, submucosal,muscular and serosal layers.DimensionsThe length varies from 2 to 20 cm with an average of 9cm.The average length is between 7.5and 10 cmIt is longer in children than in adults.The diameter is about 5-10 mm.The lumen is quite narrow and may be obliterated aftermid-adult life.PositionsThe appendix lies in the right lower quadrant in the vastmajority of patients.Two notable exceptions include patients with intestinalmalrotation, in which case the cecum and appendix are inthe left upper quadrant, and in pregnancy, in which thegravid uterus pushes the cecum and appendix into theright upper quadrant (see below).Within the right lower quadrant, the appendix can lieeithermedial, lateral, anterior,orposteriorto the cecum.Frequently, it is found in theretrocecal(65 percent) orpelvic(30 percent) positions.Although the base of the appendix is fixed, the tip canpoint in any direction
During childhood, continued growth of the caecumcommonly rotates the appendix into a retrocaecalbutintraperitoneal positionIn approximately a quarter of cases, rotation of theappendix does not occur resulting in a pelvic, subcaecalorparacaecalposition.Occasionally, the tip of the appendix becomesextraperitoneal lying behind the caecum or ascendingcolon.Rarely, the caecum does not migrate during developmentto its normal position in the right lower quadrant of theabdomenIn these circumstances the appendix can be found nearthe gall bladder or, in the case ofsitus inversusviscerum,in the left iliac fossa causing diagnosticdifficulty if appendicitis developsThe position of the base of the appendix is constant, beingfound at the confluence of the three taeniae coli of thecaecum which fuse to form the outer longitudinal musclecoat of the appendixAppendicular OrificeThe appendicular situated on the postero—medial aspectof the caecum 2 cm below the ileocaecal orifice.Its orifice opens into the cecumThe appendicular orifice is occasionally guarded by anindistinct, semilunar fold of mucous membrane known as‘valve of Gerlach’.The orifice is marked on the surface by a point situated 2cm below the junction of the trans tubercular and rightlateral planesMcBurney’s point is the site of maximum tenderness inappendicitis.The point lies at the junction of lateral one-third andmedial two-thirds of the line joining the right anteriorsuperior iliac spine to the umbilicusPeritoneal Relations
The appendix is suspended by a small, triangular thin ofperitoneum, called the mesoappendix, or appendicularmesentery.

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