Is the appendix where you think it is — And if not does it matter?

Ramsden, William; Mannion, Richard; Simpkins, K.C.; deDombal, F.T.

doi:10.1016/s0009-9260(05)81181-x

Cited by 41 publications

(24 citation statements)

References 3 publications

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“…These variations were more pronounced along the cranio-caudal axis than the medio-lateral axis. In a study based on 275 double contrast barium enemas, 35% of appendix bases were found to lie within 5 cm of McBurney's point, and 15% were >10 cm distal (5). In the present study, 89% of patients had a cranial deviation, and 64.8% a medial deviation, with reference to McBurney's point.…”

Section: Discussionsupporting

confidence: 43%

‘surface map’ of appendix – a novel tool for pre-operative demonstration of appendicular location with reference to mcburney’s point using multi-detector ct.

Ghonge¹,

Setia²,

Aggarwal³

2012

Diagn Interv Radiol

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According to conventional teaching in surgical practice, McBurney's point is the anatomical landmark for locating the appendix and is commonly described as the junction of the lateral and middle thirds of the line joining the right anterior superior iliac spine and the umbilicus (1). Several studies have, however, suggested a significant discrepancy between the McBurney's point and the exact anatomical location of the appendix (2, 3). Multidetector computed tomography (MDCT) is a "one-stop" imaging solution for effective diagnosis of acute appendicitis, with a sensitivity and specificity ranging from 87%−100% and 89%−99%, respectively (4). Similar to the way surgeons use McBurney's point to decide the site of an open appendicectomy incision, the MDCT "surface map" provides a representation of the appendicular base over the anterior abdominal wall in a single image.The present study evaluated the role of MDCT "surface mapping" of the appendix in demonstrating the variation in the location of the appendicular base with reference to McBurney's point and also to anticipate the surgical implications of these results in patients with acute appendicitis. Materials and methodsThis prospective study included a total of 74 patients who had MDCT (Somatom Sensation Cardiac 64 CT scanner, Siemens AG Healthcare, Erlangen, Germany) of the abdomen for varied clinical indications over a period of two months. Patients with a clinical history of any abdominal surgery, systemic malignancy, radiotherapy, or tuberculosis were excluded. A contrast-enhanced CT study of the abdomen was performed in venous phase with a data acquisition time of 6.15 s, scan delay of 60 s, beam collimation of 0.6 mm, gantry rotation time of 0.5 s, and pitch of 1.15. The peak tube voltage range was 100−120 kV, and the current range was 180-225 mAs, using the "care-dose" technique. The images were reconstructed at 3 mm thicknesses in the axial, sagittal, and coronal planes. Because the study did not affect the routine filming and reporting pattern, no ethical approval was required. Post-processing of the MDCT data was performed using the INSPACE software (Siemens AG Healthcare) and a "surface map" was reconstructed with a superimposed measurement grid. The software utilized the volume rendering technique (VRT) of MDCT. A detailed step-wise algorithm with explanatory images is shown in Fig. 1. An illustrative MDCT "surface map" is shown in Fig. 2. The "zero" of the measurement grid corresponded to the umbilicus on the "surface map" image. Post-processing was performed by a single CT technologist, under the direct supervision of the radiologist. The variations in the location of the appendicular base with reference to McBurney's point were tabulated along the cranio-caudal and medio-lateral axes. The location of the appendicular base along MATERIALS AND METHODSThis prospective study included a total of 74 patients who underwent an MDCT study of the abdomen for various clinical indications. Post-processing of the data was performed and a "surface map" of the a...

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Section: Discussionsupporting

confidence: 43%

‘surface map’ of appendix – a novel tool for pre-operative demonstration of appendicular location with reference to mcburney’s point using multi-detector ct.

Ghonge¹,

Setia²,

Aggarwal³

2012

Diagn Interv Radiol

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“…Publications based on contrast studies suggested that the appendix is mostly pelvic (Karim et al, 1990;Ramsden et al, 1993). The century-old belief that the base of the appendix lies at McBurney's point and that appendicectomy incisions should be centered on this point is questioned.…”

Section: Discussionmentioning

confidence: 99%

“…An anatomically precise incision was devised and tested between 1984and 1987. By 1993, with the popularization of laparoscopy and emphasis on minimally invasive surgical techniques, the size of the incision was reduced, offering a cosmetically acceptable small post-appendicectomy scar-the technique of ''minilap appendicectomy'' (Fig.…”

Section: Introductionmentioning

confidence: 99%

Variables in right iliac fossa anatomy and their relevance to appendicectomy: Improving knowledge and practices

Hegde

2008

Clinical Anatomy

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The anatomy of the right iliac fossa was reappraised with the intention of improving, open appendicectomy. The surface anatomy was studied on volunteers and the internal topography was examined during the operation of appendicectomy. Our findings vary slightly from prevailing knowledge which is mostly based on cadaver anatomy. Our findings suggest that McBurney's point is very close to the rectus sheath in some individuals and in most subjects it does not overly base of appendix. Surgical teaching through most of the 20th century stressed safety and recommended large incisions with generous exposure, allowing surgeons to operate yet not appreciate these variables. An attempt is made to provide a precise account of the variables in right iliac fossa anatomy to help surgeons operate using smaller, minimally invasive incisions with the inevitable reduced exposure of local anatomy. The proximity of the base of the appendix to the ileocaecal junction raises concern that burial of the appendicular stump might distort local anatomy.

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“…jksronline.org and adjacent bowels (7,15). The exact comparison with results of previous in vivo studies is difficult because they used different classification systems (7)(8)(9)(10).…”

Section: Patient Groupsmentioning

confidence: 99%

In VivoLocation of the Vermiform Appendix in Multidetector CT

Lee

Choi

et al. 2014

J Korean Soc Radiol

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This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.Purpose: To provide a more detailed classification system regarding the position of the vermiform appendix within the right lower quadrant, as seen on multidetector computed tomography (MDCT) and to investigate the relative differences in frequency of appendiceal position according to patient gender and the pathologic state of appendix. Materials and Methods: Between January 2008 and December 2010, 1157 patients were included in our final analysis: 542 patients with preoperative MDCT and subsequent appendectomy and 615 patients with visible appendix seen on MDCT performed as part of a health checkup. We classified the appendix according to its position relative to the cecum, the terminal ileum, and the external iliac vessels: type 1: antececal; type 2: preileal; type 3: postileal; type 4: subileal; type 5: subcecal; type 6: deep pelvic; type 7: retrocecal; and type 8: paracecal. Results: The relative incidence of various positions of the appendix found in all of our study patients was: type 1: 3.5%; type 2: 1.7%; type 3: 9.0%; type 4: 12.9%; type 5: 42.3%; type 6: 16.2%; type 7: 10.9%; and type 8: 3.0%. According to patient gender, type 1 (male: 3.7% vs. female: 3.3%), type 3 (8.6% vs. 9.8%), type 4 (14.3% vs. 9.8%), type 5 (47.5% vs. 32.7%), type 7 (9.2% vs. 14.4%), and type 8 (3.4% vs. 2.2%) positions showed a statistically significant male predominance. In terms of the inflamed state, type 2 preileal (normal: 0.8% vs. inflamed: 2.8%), type 3 (10.2% vs. 7.6%), type 4 (14.0% vs. 11.6%), and type 5 (14.1% vs. 18.5%) positions showed a statistically significant difference. Conclusion: Contrary to the common assumption that the retrocecal appendix is the most common position, the in vivo appendix is seen more often on MDCT in the subcecal and deep pelvic positions. The relative frequency of various positions of the appendix can also differ according to patient gender and the pathologic state. Index terms MDCT TechniqueCT examinations were performed using a Definition AS+ 128-detector-row CT scanner (Siemens Medical Solutions, Forchheim, Germany) after injection of intravenous contrast medium (Iopromide, Ultravist 300; Bayer Healthcare, Berlin, Germany).The images were acquired during the portal venous phase (70-s delay after contrast injection; 100 kVp; 220 mAs; pitch, 1.25; and gantry speed, 0.5 s per rotation) and included the region from the dome of the diaphragm to the symphysis pubis. CareDose 4D

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Is the appendix where you think it is — And if not does it matter?

Cited by 41 publications

References 3 publications

‘surface map’ of appendix – a novel tool for pre-operative demonstration of appendicular location with reference to mcburney’s point using multi-detector ct.

‘surface map’ of appendix – a novel tool for pre-operative demonstration of appendicular location with reference to mcburney’s point using multi-detector ct.

Variables in right iliac fossa anatomy and their relevance to appendicectomy: Improving knowledge and practices

In VivoLocation of the Vermiform Appendix in Multidetector CT

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