Anatomical Variation and Histopathology of Vermiform Appendix in Autopsy Cases

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La-or Chompuk
Weerapong Prayulsatien
Jatuwit Howannapakorn


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 gif.latex?\geq 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.

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How to Cite
Chompuk, L.- or, Prayulsatien, W., & Howannapakorn, J. (2012). Anatomical Variation and Histopathology of Vermiform Appendix in Autopsy Cases. Ramathibodi Medical Journal, 35(3), 160–169. Retrieved from
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