A pictorial essay of the most atypical variants of the vermiform appendix position in computed tomography with their possible clinical implications

Abstract

Purpose The tip of the appendix may be located in various areas of the abdominal cavity due to its variable length and/or the changeable position of the caecum. Although in the case of an atypical position the tip is usually located behind the caecum, there are possible locations that occur very rarely. Therefore, in the case of appendicitis the symptoms may lead to the wrong diagnosis. The aim of this study is to present the most atypical locations of the tip of the appendix found on CT (computed tomography) scans and thus help to avoid misdiagnoses. Imaging findings The most unusual locations of the tip of the appendix found in healthy subjects included: left inferior quadrant, along the lower edge of the liver near the gallbladder and the right kidney, the tip touching the duodenum, the rectum or appendages, and a long appendix located in the scrotum as the content of a hernia. In these positions, appendicitis may mimic acute diverticulitis, cholecystitis, duodenal ulcer, duodenitis, enteritis, or adnexal or testis pathologies. Conclusions It is important to be aware of atypical locations of the appendix because appendicitis in an unusual area may mimic other acute abdominal diseases and delay the proper treatment.

Variaciones anatómicas del apéndice cecal en tomografía, un estudio retrospectivo.

“…The appendicular base location in relation to the ileocaecal valve was also determined, and defined in three planes: anterior-posterior, medial-lateral, or superior-inferior. Both categories were established in accordance to previous reports (5,(8)(9)(10).…”

“…Contrary to other reports in which other locations are not so frequent (16,19), an interesting finding in this study was that the locations were more evenly distributed. However, has been described that given normal growth and different interventional abdominal procedures, sometimes the appendix can change position (5).…”

“…The appendix is the most variable abdominal organ in terms of position and organ relations (4), its location has always been a controversial topic and some suggest it can be related to demographic characteristics such as age, gender and race (5). There is not a consensus in the literature in relation to the different appendiceal positions in the abdominal cavity, thus many classifications have been proposed.…”

“…The tip of the appendix is free, which leads to distinct locations within the abdominal cavity (5). The base of appendix is connected to the cecum, but its head can be placed in different situations (6).…”

Apendicitis aguda de presentación atípica, un reto diagnóstico. Reporte de caso y revisión de la literatura

“…La apendicitis de ubicación típica inicia con un dolor agudo alrededor del ombligo que posteriormente migrará a la fosa ilíaca derecha [4]; su diagnóstico clínico va acompañado del aumento de glóbulos blancos, la elevación de la proteína C reactiva (PCR) y otros reactantes de fase aguda [5] y la realización de estudios de imagen como ecografía o tomografía abdominal [4]. Sin embargo, la condición de cada paciente debe ser orientada en detalles que surgen de una minuciosa anamnesis, contemplando los antecedentes del paciente y el desarrollo de la sintomatología.…”