Its a cul-de-sac (blind space).
Present usually in
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the right iliac fossa.
Size: Length-6 cm,Breadth-7.5 cm
Shape: Asymmetric.According to the shape,the cecum is
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divided into
Infantile type
? Foetal type
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? Adult type? Exaggerated type
q Relations:
? Peritoneal- Covered by peritoneum on all side
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Relations
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? Anteriorly:1. Coils of small intestine.
2. Sometimes part of the greater omentum.
3. And the anterior abdominal wall in the right iliac region.
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? Posteriorly:
1. The psoas and the iliacus muscles.
2. The femoral nerve.
3. The lateral cutaneous nerve of the thigh.
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4. The appendix is commonly found behind the cecum.? Medially:
The appendix arises from the cecum on its medial side.
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Blood SupplyArteries
Anterior and posterior cecal arteries from the ileocolic
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artery, a branch of the superior mesenteric artery.
Veins
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The veins correspond to the arteries and drain into thesuperior mesenteric vein.
Lymph Drainage
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The lymph vessels pass through several mesenteric nodes
and finally reach the superior mesenteric nodes.
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Nerve SupplyBranches from the sympathetic(T11-L1) and
parasympathetic (vagus) nerves form the superior
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mesenteric plexus.
q Interior of the cecum
It has two orifices.
? Ileo-ceacal Orifice
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? Appendicular Orifice
A narrow worm-like tubular diverticulum which
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arises from the postero-medial wall of the ceacum.Suspended by a peritoneal fold called
mesoappendix.
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The body of appendix is kinked on itself,hence
called vermiform appendix.
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Devoid of taenia coli,sacculations and appendicesepiploicae.
Large aggregations of lymphatic tissue-
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Abdominal Tonsil
Average length- 9 cm
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Presenting parts:? Base-attached to the posteromedial wall of
ceacum.
? Body-narrow,tubular and contains a canal which
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opens into ceacum.? Tip-least vascular and is directed in various
positions.
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According to the orientation of tip, appendix is
divided into following types:
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? Paracolic (11 o' clock)
? Retrocecal (12 o'clock)
? Splenic (2 o'clock)
? Promonteric (3 o'clock)
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? Pelvic type(4 o'clock)? Mid-inguinal type(6 o'clock)
Mesoappendix:
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Triangular peritoneal fol which invests the entire appendixDerived from the posterior layer of mesentery of the ileum.
Appendicular vessels pass with in the free margin of the
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mesoappendix.
Blood Supply
Arteries
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The APPENDICULAR artery- branch of the ILEO COLIC artery.
Veins
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The appendicular vein drains into ILEO COLIC vein.Lymph Drainage
The lymph vessels drain into one or two nodes lying in the
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mesoappendix and then eventually into the superior mesenteric
nodes.
Nerve Supply
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The appendix is supplied by the sympathetic and
parasympathetic (vagus) nerves from the superior
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mesenteric plexus.Afferent nerve fibers concerned with the conduction of
visceral pain from the appendix accompany the
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sympathetic nerves and enter the spinal cord at the level of
the 10th thoracic segment.
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APPENDICITISInflamation of appendix is called appendicitis.It is usually
manifested by pain,temperature and vomitting ? Murphy's
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Syndrome.The pain is often felt first in umbilical region,then settles
in the right iliac area due to local peritonitis.
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It is associated with tenderness and regidity at
McBurney's Point-represented by a point at the
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junction of medial 2/3rd & lateral 1/3rd of a linewhich extends from umbilicus to Rt. Anterior
superior iliac spine.
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In retroceacal appendicitis patient experiences pain on
extension of Rt. Hip joint due to tension of the irritated
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Rt.Psoas major muscle - Psoas Test.
Anatomical factors which cause appendicitis are-
? Faecolith in the blind lumen of appendix.
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? Supplied by an end artery.? Presence of hiatus muscularis in the muscular
coat.
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? Presence of numerous lymphatic follicles in thesub mucous coat.
The surgical removal of appendix is known as
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Appendicectomy.
If the ceacum adheres to the inferior surface of the
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liver when it returns to the abdomen,it wil bedrawn superiorly as the liver dimnishes in size.As
a result ceacum & appendix remains in the fetal
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position.
Its more common in males & occur in about 6% of
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fetuses.It may create a problem in the diagnosis of
appendicitis & appendectomy.
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Subhepatic ceacum and Appendix
It results from incomplete fixation of the ascending
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colon.
In approximately 10% people ceacum has an
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abnormal freedom & in unusual cases it mayherniate in to Rt.inguinal canal.
This condition is clinically significant as it can
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lead to Volvulus (twisting)of ceacum.
Ceacal Volvulus
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Mobile CeacumSometimes the terminal part of the ileum is
telescopically invaginated into ceacum and
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ascending colon at the ileo-ceacal junction and
produces intestinal obstruction. This phenomenon
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is called intussusception.Caecum acts as a guide in the operation of
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intestinal obstruction:-? If the ceacum is distended,obstruction occur in the
large gut.
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? If the ceacum is empty,the obstruction is of small
gut.
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