A study on morphology and the arterial supply of vermiform appendix in 50 cadavers in Tamil Nadu

Govindarajan, M (2007) A study on morphology and the arterial supply of vermiform appendix in 50 cadavers in Tamil Nadu. Masters thesis, Madurai Medical College, Madurai.

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Abstract

INTRODUCTION: It is mysterious to say that appendix is a vestigial organ, as per the usual teaching in anatomy. Since it is a part of the large gut and the narrowest part of the alimentary tract, it should not be considered as vestigial organ. Much work has been done on its structural patterns, but only meagere work on its functional aspects. So there are unknown facts yet to be elucidated, about its functional aspects. As such appendix possess all the histological features, general for the large intestine without even a small layer in its degeneration. In modern days there is much of scientific improvement so as to utilise the appendix as a grafting organ to close the fistulae so it must be considered as an evolving organ and not as vestigial organ. There are not well proved phylogenetic evidences to consider appendix as a vestigial organ. So phylogenetically and anatomically it must be considered as evolving organ with much surgical significance. MATERIALS AND METHODS The study was conducted at the Madurai Medical College, Madurai. VENUE OF THE STUDY: 1. Institute of Anatomy, Madurai Medical College, Madurai. 2. Department of Forensic Medicine, Madurai Medical College, Madurai. SAMPLE OF THE STUDY: 50 human appendix specimens, of which 35 specimens were collected from the postmortem bodies and the remaining specimens from the dissection room cadavers. AGE DISTRIBUTION: Specimens belonged to the age group between 10–80 years. The age distribution ranged between 10–80 years in male and between 16 to 63 years in female. 1. Between 0 – 20 yrs/ 7 specimens. (male 3, female 4) 2. Between 21 – 40 yrs, 29 specimens (male 14, female 5) 3. Between 41 – 60 yrs, 17 specimens (male 14, female 3) 4. Above 60 yrs, 7 specimens (male 4, female 3) METHODS: 1. Manual dissection was done in 15 cadavers in the dissection room and 25 specimens from the post mortem bodies. 2. Indian Ink was injected in five of the post mortem appendix specimens to study the arterial pattern of appendix. 3. Lead oxide was injected in five post mortem specimens and manual dissection was done. CONCLUSION: The present study of the appendix in relation to the position, length, diameter and arterial supply are compared with the earlier reports. It is observed that the appendix may occupy varying positions and so apart from the typical presentation of the appendicular mass in the right iliac fossa, it may be present in the inguinal or preileal, or infra colic or retrocolic regions. Usually the appendicular abscess is localized, but it may infect the general peritoneal cavity if it is umbilical in position. In the present study, the appendix occupied the umbilical region in 10%. The maximum tenderness, usually it is present in the McBurney’s point. But the orifice of appendix in the present study is varying in position, for example in the posteromedial wall, in the lower pole of the caecum. Because of the varying position, the point of tenderness also may be elicited at varying position. It is observed that retrocaecal position is of usual occurrence in south Indian races and so the appendicular abscess is localized, usually it diagnosed without much difficulty. If retrocolic, it is behind the ascending colon and it may be time consuming to come to a definite diagnosis. If it is pelvic in position appendicitis is usually associated with pelvic peritonitis. It may present as a pararectal abscess or may mimic a pararectal abscess. In females it leads to pelvic peritonitis of the posterior compartment and may present as an abscess in the douglass pouch. If the appendix comes in to contact with ovary or fallopian tube, appendicitis may be complicated with salphingitis and oopheritis or a mere pelvic position may mimic salphingitis or oopheritis and difficulties may be encountered to come to a definite diagnosis. In the present study the postileal position was observed in 10% of cases. In postileal position the tip and the shaft of the appendix is present between the two layers of the mesentry at its root. So it may be present as retroperitonial abscess along the root of the mesentry. If the length of the appendix is longer it is within the two layers which causes lymphadenitis with lymphatic stasis, compression to the veins with venous stasis, the stasis of both giving rise to inflammatory oedema in the mesentry and in the small intestine. Inflamatory arteritis due to infection spreading from the lymphnodes or compression by the enlarged lymphnodes leading to thrombus formation in the vasarecta or in the arcades and if massive in the superior mesenteric artery itself leading to either localised ischemia to a particular region or whole of the gut supplied by the superior mesenteric artery finally leading to the gangrene of the bowl. The study of the diameter of the appendix is important in that, if the diameter in the ultrasonographic study is more than 6mm it is considered as a sign of appendicitis. The arterial pattern gains importance in relation to the ligation and division of the arteries. If the artery is directly in contact with the wall of the appendix it may be subjected to earlier periarteritis and thrombus formation. But if it is within the layers of the mesoappendix, the involvement of the artery may be late. So it is concluded that apart from the typical presentation of the appendix as described in the anatomical text books, it is observed that a position which is rare in some race becomes trivial in other races. We could not exclude that there are rarities and any presentaion must be given equal importance in order to prevent later complications.

Item Type: Thesis (Masters)
Uncontrolled Keywords: morphology, arterial supply, vermiform appendix, 50 cadavers.
Subjects: MEDICAL > Anatomy
Depositing User: Subramani R
Date Deposited: 05 Oct 2019 07:45
Last Modified: 05 Oct 2019 14:17
URI: http://repository-tnmgrmu.ac.in/id/eprint/11684

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