Pelvic appendix

Abstract: Transvaginal ultrasonography (US) is a noninvasive, readily available imaging technique that has greatly enhanced diagnostic sensitivity and accuracy for both gynecologic and nongynecologic disease. High-frequency US probes placed in the vagina allow high-resolution assessment of all the pelvic viscera, including portions of the gut and urinary tract. In addition, they allow visualization of the peritoneum of the pelvic pouch and the pelvic side walls without interference from bowel gas or adipose tissue. Evaluation of these areas requires a modified US technique that includes the use of the highest-frequency probes with angulation of the transducer to allow assessment of the region of interest. In women of childbearing age, the similarity of symptoms in gynecologic and gastrointestinal tract disease in particular underscores the potential utility of transvaginal US, which may, for example, help differentiate appendicitis in a pelvic appendix from pelvic inflammatory disease. Transvaginal US may also help determine the correct course of therapy, thereby improving patient management. Other indications for transvaginal US include assessment for pelvic appendicitis and diverticulitis, rectal and perianal complications of Crohn disease, and ureteric and bladder calculi and tumors as well as evaluation of the anal sphincters in women with fecal incontinence. Transvaginal US is also superior to routine US in the detection and characterization of ascites and peritoneal disease. Transvaginal US examination should include the entire pelvic cavity and contents, especially in women at risk for pelvic sepsis or peritoneal disease.

Abstract: This is a study of the positions of the appendix in 548 Nigerians 447 of whom were autopsies or cadavers while the rest (101) were appendicectomy patients. Overall, the retrocaecal appendix was the commonest because of its very high frequency in the surgical material. The pelvic appendix as distinct from the retrocaecal or retrocolic was the commonest in the nonsurgical cases and it also had an increasing frequency with age. When previous reports were reviewed, the retrocaecal position was moderately infrequent in blacks compared to causasians.

Abstract: Background: Vermiform appendix performs function immunologically and acts like a tonsil. The objective of the study was to determine different positions of appendix in people of district Bannu. Methods: It was a cross-sectional descriptive study conducted in district Bannu from January 1, 2009 to December 31, 2009. Sample size was 500, including appendices during surgery in acute abdomen, postmortem, and among dissected bodies. Vermiform appendices were observed in situ and positions recorded accordingly. Results: The age ranges was 1 to 60 years. Retrocaecal position was highest (57%) followed by pelvic (28.6%), post-ileal (9.4%) and pre-ileal (4%). The paracaecal and ectopic varieties were 5%. Conclusion: Retrocaecal is the commonest position followed by pelvic appendix.

Abstract: Aim was to study morphological variations of vermiform appendix and caecum. 60 embalmed donated cadavers (30 male and 30 female) were dissected to study morphological variations of vermiform appendix and caecum in the department of Anatomy of Grant Government Medical College, Byculla, Mumbai, India. Position, length, outer girth of appendix, distance of appendix from ileocaecal junction, shape, length and width of caecum were studied. Sex differences and relation between shape of caecum and position of appendix were studied. Photographs were taken for proper documentation. Most common position of vermiform appendix was retrocaecal 56.67% then pelvic 25%, preileal 15% and postileal 3.33%. In males it was retrocaecal 23.33% then pelvic 15%, preileal 8.33% and postileal 3.33%. In females it was retrocaecal 33.33% then pelvic 10%, preileal 6.67%. Average length of appendix was 5.93 cm. In males it was 6.30 cm and in females it was 5.55 cm. Average outer girth of appendix was 2.80 cm. In males it was 2.83 cm and in females it was 2.76 cm. Average distance of appendix from ileocaecal junction was 2.47 cm. In males it was 2.63 cm and in females it was 2.31 cm. Most common shape of caecum was adult 73.33%, exaggerated 13.33%, infantile 8.33%, fetal 5%. In males it was adult 33.33%, exaggerated 10%, infantile 3.33%, and fetal 3.33%. In females it was adult 40%, exaggerated 3.33%, infantile 5% and fetal 1.67%. Average length of caecum was 7.52 cm. In males it was 8.07 cm and in females it was 6.97 cm. Average width of caecum was 8.48 cm. In males it was 9.05 cm and in females it was 7.92 cm. Out of total retrocaecal appendix 76.5% were with adult caecum, 11.8% were with exaggerated caecum, 8.8% were with infantile caecum, 2.9% were with fetal caecum. Out of total pelvic appendix 73.3% were with adult caecum, 13.3% were with infantile caecum, 13.3% were with fetal caecum and none of them were exaggerated. Out of total preileal appendix 55.6% were with adult caecum, 44.6% were with exaggerated caecum and none of them were fetal and infantile. Out of total postileal appendix 100% were with adult caecum and none of them were exaggerated, infantile or fetal. The knowledge of anatomy of vermiform appendix and caecum is of significant importance during surgical and radiological procedure to avoid any catastrophical complication.