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