A different view of the sonographic classification of the appendix

Abstract

Aim: We intended to detect various appendix localisations with a classification system different from those used in previous literature to facilitate the sonographic detection of the appendix. Patients and methods:The study was performed on 362 consecutive patients who applied to our department for abdominal or pelvic US examination to our department. The sonographic criterion used to diagnose a normal appendix was visualization of the full extension of a compressible, blind-ending tubular structure with a maximum transverse diameter of 6 mm. Appendices were evaluated by US and localisations were recorded and classified according to the reference line passing through the iliac vessels in the right iliac fossa.Results: Each appendix was classified as type 1 to 8 according to its location. Type 1 crossed the iliac vessels (85.5%), type 2 was medial to the iliac vessels (2.41%), type 3 was inferior and lateral to the cecum (1.93%), type 4 was in the right paracolic gutter (4.34%), type 5 was completely retrocecal (1.93%), type 6 was in front of the cecum (1.45%), type 7 extended to the umbilicus (0.97%) and type 8 was subhepatic with cecal malposition (1.45%). Conclusion:The study demonstrated a new classification system (types 1-8) different from those described in previous literature. The most common position of the normal and abnormal appendices in our study was crossing the iliac vessels (type 1). The second most common position was the right paracolic gutter (type 4). Two interesting localisations extended to the umbilicus (type 7) and appeared in the subhepatic space (type 8).

Variations and morphometric features of the vermiform appendix: A systematic review and meta‐analysis of 114,080 subjects with clinical implications

“…The lack of standardization in naming VA positions, the use of different names for the same locations, and unclear definitions resulted in inconclusive findings about the most frequent location of the VA. Some anatomical and surgical studies employed the categorization method proposed by Wakeley in 1933 (Wakeley ); however, their own new modifications often fostered even more confusion (Ojeifo et al ; Dronov et al ; Bakheit and Warille ; Jan et al ; Ndoye et al ; Thyagaraj ; Caravaggio et al ; Iqbal et al ; Turkoglu et al ; Patel et al ; Sinha ; Zachariah ; Casado Méndez et al ; Lee et al ; Mwachaka et al ; Yaqoob et al ; Kondo et al ; Kumar and Hai ; İnal et al ; Kulhan et al ; Sinha et al ; Aneiros Castro et al ). Consequently, due to all these obstacles, data derived from different studies was difficult to compare.…”