Anatomical Variation and Histopathology of Vermiform Appendix in Autopsy Cases
Keywords:
Appendix, Appendicitis, Mesoappendix, Position, VariationAbstract
Background: Acute appendicitis is one of the most common diseases that needs emergency surgery. Some patients have atypical symptoms and physical findings that may lead to a delay in diagnosis and increased complications. Atypical presentation may be related to the position of the appendix. Normally, the appendix is located in right lower abdominal cavity. The base is connected to the cecum, while the distal part is variable. Mesoappendix is a triangular-shape fat connecting the ileal mesentery and appendix. Failure to reach the appendiceal tip of mesoappendix may result in appendiceal gangrene and perforation during inflammation.
Objectives: The aim of this study is to determine variations of the position, length, diameter, content, histopathology and mesoappendix in autopsy cases and to comparison these parameters between sex and age groups.
Results: The results showed total 257 autopsy cases. There were male 288 cases (80.7%), female 69 cases (19.3%), adult (age 18 year-old) 331 cases (92.7%) and children (age < 18 year-old) 26 cases (4.3%). Pelvic position was the predominant position 283 cases (79.3%), followed by retrocecal 48 cases (13.4%), post-ileal 25 cases (7%) and pre-ileal 1 case (0.3%), respectively. The average length was 7.6 cm (rang 3-16 cm). The average diameter was 0.62 cm (rang 0.3-1 cm). The content were fecal material 322 cases (90.2%), fibrous obliteration 22 cases (6.2%) and no material 13 cases (3.6%), respectively. Histological finding revealed unremarkable 180 cases (50.4%), eosinophilia 96 cases (26.9%), autolysis 39 cases (10.9%), fibrous obliteration 22 cases (6.2%), lymphoid hyperplasia 8 cases (2.2%) and plant seed 1 case (0.3%). There were 331 cases (92.7%) that mesoappendix can reach to the appendiceal tip and 26 cases (7.3%) failed to reach the tip. The position was not different between sex and age groups (P < 0.05). Male had more length, diameter and fecal material than female. Adult had more fecal material and fibrous obliteration more than children. Eosinophilia was found predominantly in male, where as fibrous obliteration was found mostly in female. There was no differentiation of the length, diameter and histopathology between age group.
Conclusion: Reaching to the tip of mesoappendix was not different between sex. But adult had more failure to the tip of mesoappendix than children. Pelvic position is the most common location in our study. Failure to the tip of mesoappendix was about 7.3%. These data showed variations of vermiform appendix that will help the clinicians to make a diagnosis of appendicitis and aware about appendiceal rupture.
References
Glover JW. The human vermiform appendix - A general surgeon’s reflections. EN Tech J. 1988;3:31-8. Available from: https://creation.com/images/pdfs/tj/j03_1/j03_1_031-038.pdf.
Bhasin AK, Khan AB, Kumar V, Sharma S. Vermiform appendix and acute appendicitis. JK Science. 2007;9(4):167-70. Available from: https://jkscience.org/archive/volume94/Review%20Article/VERMIFORM%20APPENDIX.pdf.
Ong EM, Venkatesh SK. Ascending retrocecal appendicitis presenting with right upper abdominal pain: utility of computed tomography. World J Gastroenterol. 2009;15(28):3576-9. doi:10.3748/wjg.15.3576.
Wani I. K-sign in retrocaecal appendicitis: a case series. Cases J. 2009;2:157. doi:10.1186/1757-1626-2-157.
Hardin DM Jr. Acute appendicitis: review and update. Am Fam Physician. 1999;60(7):2027-34.
Ahmed I, Asgeirsson KS, Beckingham IJ, Lobo DN. The position of the vermiform appendix at laparoscopy. Surg Radiol Anat. 2007;29(2):165-8. doi:10.1007/s00276-007-0182-8.
Golalipour MJ, Arya B, Azarhoosh R, Jahanshahi M. Anatomical variations of vermiform appendix in South-East. Caspian Sea (Gorgan-IRAN). J Anat Soc India. 2003;52(2):141-3. Available from: https://medind.nic.in/jae/t03/i2/jaet03i2p141.pdf.
Porncharoenpong S. Pathologycal findings of vermiform appendix in Buddhachinaraj Hospital during 2003-2006. Asian Arch Pathol. 2007;5:109-16.
Ohmann C, Yang Q, Franke C. Diagnostic scores for acute appendicitis. Abdominal Pain Study Group. Eur J Surg. 1995;161(4):273-81.
Wakeley CP. The position of the vermiform appendix as ascertained by an analysis of 10,000 cases. J Anat. 1933;67(Pt 2):277-83.
Bakheit MA, Warille AA. Anomalies of the vermiform appendix and prevalence of acute appendicitis in Khartoum. East Afr Med J. 1999;76(6):338-40.
Petras RE, Goldblum JR. Appendix. In: Damjanov I, Linder J, eds. Anderson's Pathology. 10th ed. Missouri, USA: Mosby; 1996:1728-32.
Cotran RS, Kumar V, Robbins SL. Robbins Pathologic Basis of Disease. 5th ed. Philadelphia: W.B. Saunders; 1994;823-4.
Rosai J. Rosai and Ackerman's Surgical Pathology. 9th ed. St Louis: Mosby; 2004:757-60.
Lamps LW. Appendicitis and infections of the appendix. Semin Diagn Pathol. 2004;21(2):86-97. doi:10.1053/j.semdp.2004.11.003.
Porter HJ, Padfield CJ, Peres LC, Hirschowitz L, Berry PJ. Adenovirus and intranuclear inclusions in appendices in intussusception. J Clin Pathol. 1993;46(2):154-8. doi:10.1136/jcp.46.2.154.
Paul U, Naushaba H, Begum T, Alamq M, Alim A, Akther J. Position of vermiform appendix: a postmortem study. Bangladesh J Anat. 2009;7(1):34-36. doi:10.3329/bja.v7i1.3015.
Shanks SC. Congenital abnormalities of the colon. Brit. J. Radiol. 1937;10:261-81.
Ojo OS, Udeh SC, Odesanmi WO. Review of the histopathological findings in appendices removed for acute appendicitis in Nigerians. J R Coll Surg Edinb. 1991;36(4):245-8.
Evbuomwan L, Iyasere OG. The vermiform appendix in the inguinal canal. An unusual abnormal position--a case report and review of literature. West Afr J Med. 2002;21(1):82.
Malla BK. A study on 'Vermiform Appendix'--a caecal appendage in common laboratory mammals. Kathmandu Univ Med J (KUMJ). 2003;1(4):272-5.
Marniok B, Slusarczyk K, Pastuszka A, Jarosz R. Anatomical variations of vermiform appendix. Wiad Lek. 2004;57(3-4):156-7.
Ndoye JM, Ndiaye A, Ndiaye A, Dia A, Fall B, Diop M, et al. Cadaveric topography and morphometry of the vermiform appendix. Morphologie. 2005;89(285):59-63. doi:10.1016/S1286-0115(05)83239-4.
Clegg-Lamptey JN, Armah H, Naaeder SB, Adu-Aryee NA. Position and susceptibility to inflammation of vermiform appendix in Accra, Ghana. East Afr Med J. 2006;83(12):670-3.
Ting JY, Farley R. Subhepatically located appendicitis due to adhesions: a case report. J Med Case Rep. 2008;2:339. doi:10.1186/1752-1947-2-339.
Kubíková E, El Falougy H, Mizerákova P, Cingel V, Benuska J. Position variability of the vermiform appendix and effect on diagnosis of appendicitis in children. Rozhl Chir. 2009;88(3):133-5.
Ma KW, Chia NH, Yeung HW, Cheung MT. If not appendicitis, then what else can it be? A retrospective review of 1492 appendectomies. Hong Kong Med J. 2010;16(1):12-7.
Shperber Y, Halevy A, Oland J, Orda R. Familial retrocaecal appendicitis. J R Soc Med. 1986;79(7):405-6. doi:10.1177/014107688607900708.
Denjalić A, Delić J, Delić-Custendil S, Muminagić S. Variations in position and place of formation of appendix vermiformis found in the course of open appendectomy. Med Arh. 2009;63(2):100-1.
.png){kind=logo}
