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Case Report
Introduction the Medical Faculty of the University of Sofia. The cadaver belonged
to a 70-year-old woman and was fixed with the formaldehyde
The topography of the large intestine and the additional elements, method. When observing the abdominal organs and their positions,
like the appendix, are well known, but their variants deserve further we discovered the unusual position and size of the VA. The position
attention. The most common variants are observed in the length and of the VA was retroperitoneal and retrocaecal. The curve of the VA
positions of the appendix. The topography of the vermiform appendix was extreme, and passed through the ascending part of the colon and
depends on the neighbor organs and the attaching apparatus of the
against the liver. The size of the VA was 16.3cm (Figure 1). Typically
peritoneum (mesoappendix). The main variants are Retrocaecal,
the caecum is located intra peritoneally in the lower right abdomen
Subcaecal, Paracaecal, Post Ileal, Pelvic and Preileal positions. If a
and has a length of 5 to 7 cm. The VA attached itself with a double
patient was to have some of the listed variants, he/she normally would
peritoneal layer to the back of the abdominal wall, becoming the
not feel any specific symptoms. But inflammation of an appendix
mesoappendix (Figure 2). Here taeniae, haustra and semi lunar folds
positioned abnormally may imitate diseases, like: colits, pelvic
were all absent. The diameter of the VA was approximately 0.8 cm.
inflammatory disease, sub hepatic – hepatitis, torsion of the ovarian
cyst, etc. The Vermiform Appendix (VA) has the role of a tonsil. Both The topography of the parts of the colon also showed peculiarities,
of these structures are composed of lymphatic tissue. The appendix in which differed from the norm. After the left colic flexure, the
surgical practice is detected by tracing the three longitudinal muscle descending colon was directed downwards and near to the left
layers, whose terminal fusion composes the proximal part of the gut
extension. The growth of longitudinal muscle layers (the taeniacolli)
may confuse the surgeon about the real position of the appendix.
The Sigmoid Colon is the terminal section of the large intestine
and is situated in the pelvic region. The anterior part of the colon
is separated from the bladder in the male, and from the uterus in
the female. The external iliac vessels, the left sacral plexus and the
left piriformis muscle are situated posterior the sigmoid colon.
Diverticulitis often occurs in the sigmoid colon. The unusual size,
topography and relationships were documented.
Case Presentation
During our academic dissection of the cadaver, completed with
the help of medical students, we encountered an unusual length of the
Vermiform Appendix (VA), as well as an abnormal size, position and
curves of the descendent and Sigmoid Colon. The medical students Figure 1: Unusual length of the vermiform appendix.
VA: Vermiform Appendix; C: Caecum
were from the Department of Anatomy, Histology and Pathology, at
Austin J Anat - Volume 2 Issue 3 - 2015 Citation: Maslarski I. Unusual Position and Size of the Appendix and the Sigma Colon. Austin J Anat. 2015;
ISSN : 2381-8921 | www.austinpublishinggroup.com 2(3): 1040.
Maslarski. © All rights are reserved
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Colon or the appendix. As mentioned earlier in this case report, the References
mesoappendix of the appendix and the sigma colon were in close 1. Geethanjali H, Lakshmi P. A Study of Variations in the Position of Vermiform
contact. The contact can be explained with the common embryonic Appendix, Anatomica Karnataka. 2011; 5: 17-23.
origin of these Mesentery structures. 2. Wakeley CP. The position of the vermiform appendix as ascertained by
analysis of 10000 cases. J Anat. 1933; 67: 277-283.
Variations in the length and position of the VA and of the Sigmoid
3. Hardin DM. Acute Appendicitis: Review and Update, Am Fam Physician.
Colon may lead to some pathological conditions. The redundant loop
1999; 60: 2027-2034.
of the Sigmoid Colon can cause various problems such as indigestion,
insomnia, pain in the right iliac fossa or loss of weight. Some cases [7] 4. Hafferl A. Lehrbuch der topographischen anatomie, Springer – Verlag, Berlin.
are known for the excessively long distal part of the colon, including 5. Floch M. Netter’s Gastroenterology, 2nd edition. Saunders Elsevier,
the right-sided Sigmoid Colon. There is some variation in the Philadelphia. 2009; 367-370.
position of the Sigmoid Colon in adults, however, as the radiographs 6. Moore K, Persaud T. Before we are born- Essentials of embryology and birth
show [8]. (It was noticed that, on radiographs of young children, the defects. Saunders Company, Philadelphia. 1998; 273-280.
Sigmoid Colon was often positioned within the right lower quadrant, 7. Nayak SB. George BM, Mishr S. Abnormal Length and Position of the
as opposed to the left lower quadrants in adults). The Sigmoid Colon Sigmoid Colon and Its Clinical Significance. 40; 2012; 10: 94-97.
in this case could be mistaken for the caecum or the ascending colon 8. Prassopoulos P, Gourtsoyiannis N, Cavouras D, Pantelidis N. Interposition
and lead to false diagnosis. of the colon between the kidney and the psoas muscle: a normal anatomic
variation studied by CT, Abdominal imaging, Springer – Verlag, New York.
The description of this case could improve diagnostic activity 1994; 19: 446- 448.
during the radiological studies and be beneficial for future surgical
practice.
Austin J Anat - Volume 2 Issue 3 - 2015 Citation: Maslarski I. Unusual Position and Size of the Appendix and the Sigma Colon. Austin J Anat. 2015;
ISSN : 2381-8921 | www.austinpublishinggroup.com 2(3): 1040.
Maslarski. © All rights are reserved
Submit your Manuscript | www.austinpublishinggroup.com Austin J Anat 2(3): id1040 (2015) - Page - 03