"" Unusual Position and Size of the Appendix and the Sigma Colon

Case Report

Austin J Anat. 2015; 2(3): 1040.

Unusual Position and Size of the Appendix and the Sigma Colon

Maslarski I*

Department of Anatomy, histology and pathology, University of Medical Faculty at the Sofia, Bulgaria

*Corresponding author: Maslarski I, Department of Anatomy, histology and pathology, University of Medical Faculty at the Sofia, Bulgaria

Received: August 10, 2015; Accepted: August 20, 2015; Published: November 13, 2015

Abstract

The topography of the large intestine and the additional elements, like the appendix, are well known, but their variants deserve further attention. During our academic dissection of the cadaver, completed with medical students, we encountered unusual length of the Vermiform Appendix (VA), as well as abnormal size, position and curves of the descending and Sigmoid Colon. The position of the VA was retroperitoneal and retrocaecal. The size was 16.3 cm. The topography of colon parts also showed peculiarities, which differed from the norm. After the left colic flexure, the descendent colon was directed down and close to the left portions of the small intestine. Instead of moving curve less to the lower left abdomen, the colon was directed obliquely and to the right, and passed to the caecum. The observed position of the large intestine led us to the description of its topographic classification, embryonic origin and attaching apparatus. This unusual move of the descendent colon and the subsequent sigma makes the case interesting for the abdominal surgical practice.

Keywords: Vermiform appendix; Sigmoid colon; Mesentery

Introduction

The topography of the large intestine and the additional elements, like the appendix, are well known, but their variants deserve further attention. The most common variants are observed in the length and positions of the appendix. The topography of the vermiform appendix depends on the neighbor organs and the attaching apparatus of the peritoneum (mesoappendix). The main variants are Retrocaecal, Subcaecal, Paracaecal, Post Ileal, Pelvic and Preileal positions. If a patient was to have some of the listed variants, he/she normally would not feel any specific symptoms. But inflammation of an appendix positioned abnormally may imitate diseases, like: colits, pelvic inflammatory disease, sub hepatic – hepatitis, torsion of the ovarian cyst, etc. The Vermiform Appendix (VA) has the role of a tonsil. Both of these structures are composed of lymphatic tissue. The appendix in surgical practice is detected by tracing the three longitudinal muscle layers, whose terminal fusion composes the proximal part of the gut extension. The growth of longitudinal muscle layers (the taeniacolli) may confuse the surgeon about the real position of the appendix.

The Sigmoid Colon is the terminal section of the large intestine and is situated in the pelvic region. The anterior part of the colon is separated from the bladder in the male, and from the uterus in the female. The external iliac vessels, the left sacral plexus and the left piriformis muscle are situated posterior the sigmoid colon. Diverticulitis often occurs in the sigmoid colon. The unusual size, topography and relationships were documented.

Case Presentation

During our academic dissection of the cadaver, completed with the help of medical students, we encountered an unusual length of the Vermiform Appendix (VA), as well as an abnormal size, position and curves of the descendent and Sigmoid Colon. The medical students were from the Department of Anatomy, Histology and Pathology, at the Medical Faculty of the University of Sofia. The cadaver belonged to a 70-year-old woman and was fixed with the formaldehyde method. When observing the abdominal organs and their positions, we discovered the unusual position and size of the VA. The position of the VA was retroperitoneal and retrocaecal. The curve of the VA was extreme, and passed through the ascending part of the colon and against the liver. The size of the VA was 16.3cm (Figure 1). Typically the caecum is located intra peritoneally in the lower right abdomen and has a length of 5 to 7 cm. The VA attached itself with a double peritoneal layer to the back of the abdominal wall, becoming the mesoappendix (Figure 2). Here taeniae, haustra and semi lunar folds were all absent. The diameter of the VA was approximately 0.8 cm.