Different positions of Appendix comparison betweeDISCUSSIONS The Vermiform appendix may occupy one of the several positions
Different positions of Appendix comparison betweeDISCUSSIONS
The Vermiform appendix may occupy one of the several positions. The direction of the tip of the appendix is taken as the criterion to describe the position of the appendix. Various authors quoted different percentages of frequency of occurrence. Gray10 has described the positions as retro-caecal, retro-colic, pelvic, sub-caecal, pre-ileal and post-ileal. Wakely12 described the position of vermiform appendix as retro-caecal and retro-colic (65.28%), pelvic (31%), sub-caecal (2.26%), pre-ileal (1%) and post-ileal (0.4%). Buschard and Kjaeldgaard classified positions as anterior (pelvic and ileo caecal) and posterior (retro caecal and subcaecal). They observed posterior positions are more common in Danish people. Wakely and Gladstone, both described the positions of the appendix as retro-caecal (64%), pelvic(32%), they described that sub-caecal and splenic positions are rare. According to Lockhart the positions of vermiform appendix are retro-caecal (65%), pelvic (30% ), remaining (5%) are of sub-caecal or pre-ileal or post-ileal in position. Khan7 described the position of appendix as retro-caecal and retro-colic (65%), pre-ileal and pelvic (30%), right para colic and sub-caecal (2%) and ileo-colic (1%). Dutta classified the different positions of the appendix as sub-caecal and paracolic (2%), retro-caecal and retro-colic (60%) splenic 1-2%), promontoric (rare), pelvic (30%) and mid-inguinal which is rare.
In the present study the position of appendix in adult specimens is as follows. Preileal (8%) retro caecal (60%) Midinginal (16%) Promonteric (12%) Subhepatic (4%) These observations are not in conformity with any of the above authors because they have used different criteria.
In fetuses the positions of the appendix are observed as retro-caecal 40%, Pre-ileal 8% and mid-inguinal 20% promonteric 24%. These observations could not be compared as no proper literature is available.
It is a triangular fold of peritoneum enclosing the blood vessels, nerves and lymph vessels of the vermiform appendix. This extends to a variable length. As per Gray, Keith.L.Moore and A.K.Dutta1 the meso-appendix extends up to the tip of the appendix. As per R.J.Last and Hollinshead the meso-appendix extends to a variable length.
In 4 adult specimens of the present study the meso-appendix is complete which is in conformity with the descriptions given by Gray, Keith.L.Moore and A.K.Datta.In the rest of the specimens the extent of meso-appendix is coinciding with the findings of R.J.Last and Hollinshead2.
In 4 foetal specimens of the present study the meso-appendix is complete and in 9 foetal specimens it is incomplete. These observastions could not be compared as no proper literature is available.
Peritoneal reflections of appendix
According to wood Burne and Sahana3 the vermiform appendix is completely covered with peritoneum. In the present study also in all the adult specimens the appendix is fully covered by peritoneum which is in conformity with description given by the above authors.
In all fetuses also the appendix is fully covered by peritoneum. No literature is available regarding peritoneal covering of vermiform appendix in fetuses for comparison.
Length and breadth of appendix in adult and foetal specimens
The length of the vermiform appendix in adults varies widely from 20 mm to 250mm as described by different authors, the average ranging from 75mm to 100mm. In the present study, the length of the appendix is ranging from 40 mm to 90 mm which is within the range described by the authors shown in the table No. 22. But the average length 60 mm which is less when compared to that of the above authors Very few authors described the breadth of appendix. In the present study, the average breadth of appendix in adults is 7.8 mm which is nearer to the breadth given by Lockhart 4 and Cunningham6.
In all 25 foetal specimens, the length of the appendix is ranging from 25 mm to 50 mm and the average being 27 mm. The breadth in all 25 foetal specimens is ranging from 2 mm to 5 mm with an average of 2.5 mm. This findings could not be compared as the literature is not available.
Arterial Supply of Caecum
Regarding the origion of the ileo-colic artery G ray, Grant, Cunningham, Buchanan, Anson, R.J.Last, Morris, Nicholas and Michels, Wood Burne have described that it is arising independently from the right side of the superior mesenteric artery. In the present study in all 25 adult specimens (100%) the ileo-colic artery is arising independently from the right side of the superior mesenteric artery which is in conformity with the description of above authors.
In all foetal specimens (100%) also the ileo-colic artery is arising independently from the right side of the superior mesenteric artery.
n adult cadaver and dead fetus – An original report