Congenital abnormalities and anatomical variations of the vermiform appendix and mesoappendix

Vieira, Elciana de Paiva Lima; Bonato, Larissa Milton; Silva, Gabriela Gonçalves Pereira da; Gurgel, Jonas Lírio

doi:10.1016/j.jcol.2019.04.003

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Journal of Coloproctology (Rio de Janeiro)

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Review Articles • J. Coloproctol. (Rio J.) 39 (3) • Jun-Sep 2019 • https://doi.org/10.1016/j.jcol.2019.04.003 copy

Congenital abnormalities and anatomical variations of the vermiform appendix and mesoappendix

Anomalias congênitas e variações anatômicas do apêndice vermiforme e mesoapêndice

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Aim:

The purpose of this review was to present and discuss the anatomical variations and congenital abnormalities of the vermiform appendix and mesoappendix reported in recent years, and their associations with acute appendicitis and other associated pathologies.

Methods:

The search was carried out in the following databases: PubMed, Science Direct, and SciELO.

Results:

Thirty-seven studies were included in this review. Among the abnormalities of the vermiform appendix identified are agenesis and duplicity, and anatomical variations were related to length and positioning. Appendicular duplicity was a more frequent abnormality, mainly Type B2, associated with acute appendicitis, followed by agenesis, Type III. The first case of agenesis associated with acute appendicitis and volvulus-type duplicity of the appendix was identified. The most frequent position was retrocecal in adults and pelvic in children. In the mesoappendix, anatomical variations in its positioning, shape, absence, and length were identified.

Conclusion:

This review sought to present and discuss the anatomical variations and congenital abnormalities of the vermiform appendix and mesoappendix reported in recent years, and their associations with acute appendicitis and other associated pathologies, contributing to aid in clinical diagnosis and surgical interventions in patients with suspected acute appendicitis.

Keywords:
Vermiform appendix; Anatomical variation; Congenital abnormalities

Authors	Sex	Age (years)	Type
Maitra et al.⁹9 Maitra TK, Roy S, Mondal SK, Mahjabin S. Absent appendix. Bangladesh Crit Care J. 2013;1:109-10.	Female	45	III
Vicent et al.¹⁰10 Vicent MV, Doyle A, Bernstein S, Jackman S. Absence of the appendix discovered during childhood. Springer Plus. 2014;3:522-5.	Male	14	III
Shah¹¹11 Shah TA. A 25-year-old male with appendicular agenesis: a case report and literature review. J Taibah Univ Sci. 2017;12:75-7.	Male	25	III
Andrade⁸8 Andrade L. A very rare association: acute apendagitis and appendicular agenesis, case report. MOJ Clin Med Case Rep. 2016;4:00095.	Female	4	III
Tripathy¹²12 Tripathy BB. Congenital absence of appendix: a Surgeon's dilemma during surgery for acute appendicitis. J Indian Assoc Pediatr Surg. 2016;21:199-220.	Male	5	III
Loli et al.¹³13 Loli YT, Contreras CC, Cabanillas J. Apendicitis crónica en un apêndice atrófico: reporte de um caso. Horiz Med. 2016;16:71-5.	Male	24	IV

Authors	Sex	Age (years)	Type	State of the appendices
Mahmood et al.⁵5 Mahmood A, Mahmood NF, Willians JL. Acute abdominal pain presenting as a rare appendiceal duplication: a case report. J Med Case Rep. 2012;6:79.	Female	15	A	No inflammation of the appendices.
Rashid et al.²⁸28 Rashid A, Younus U, Kakroo SM, Wani AH. Appendicular duplication with gangrenous appendicitis in a 10-year-old child: a case report. J Park Med Stud. 2012;2:98-100.	Male	10	A	One of the appendices gangrened.
Muhstaque et al.²³23 Mushtaque M, Mehraj A, Khanday SA, Dar RA. Double appendicitis. Int J Clin Med. 2015;3:60-1.	Male	16	B2	One of the appendices gangrened.
Oruç et al.²⁹29 Oruç C, Isik O, Üreyen O, Kahyaoglu OS, Kö Seoglu A. An extremely rare appendiceal abnormality: horseshoe appendicitis. Ullus Travma Acil Cerrahi Derg. 2013;19:385-6.	Female	64	D	Presence of adhesions that hinder the mobilization of the appendix.
Bulut et al.³⁰30 Bulut SP, Cabioglu N, Akinci M. Perforated double appendicitis: horseshoes type. Ullus Cerrahi Derg. 2016;32:134-6.	Male	52	D	Local inflammation.
Dubbashi et al.¹⁸18 Dubhashi SP, Dubhashi UP, Kumar H, Patil C. Double appendix. Indian J Surg. 2015;77:1389-90.	Female	24	B2	Only one inflamed appendix.
Christodoulidis et al.³¹31 Christodoulidis G, Symeonidis D, Spyridakis M, Koukolis G, Manolakis A, Triantafylidis G, et al. Acute appendicitis in a duplicated appendix. Int J Surg Case Rep. 2012;3:559-62.	Female	23	-	Only one inflamed appendix.
González et al.³²32 González GH, Vega AFM, Delgado CTC, Talamantes LAC, Sánchez CNA. First case of a vermiform appendix duplication type A volvulus: a very rare cause of acute abdomen. J Ped Surg Case Rep. 2015;3:374-6.	Female	7	A	Volvulus of the appendix Necrosis of the intestine.
Alves et al.¹⁷17 Alves JR, Maranhão IGO, Oliveira PVV. Appendicitis in double cecal appendix: case report. World J Clin Cases. 2014;2:391-4.	Male	36	B	Both appendices were swollen.
Nazir et al.²²22 Nazir S, Bulanov A, Ilyas M, Jabbour I, Griffith L. Duplicate appendix with acute ruptured appendicitis: a case report. Int Surg. 2015;100:662-5.	Female	33	B2	Only one inflamed appendix.
Panda et al.³³33 Panda SK, Tirkey CPR, Rajesh V, Mishra J, Dora RK. Unusual association of Meckel's diverticulum with double appendix - a rare finding. Int J Surg Case Rep. 2014;5:879-81.	Male	24	B1	Only one inflamed appendix, associated with diverticulitis in the Meckel's diverticulum.

Authors	n	Age (years)	Length (cm)/sex	State of the appendix and mesoappendix
Bakar et al.³⁹39 Bakar S, Shamim M, Ala G, Sarwar M. Negative correlation between age of subjects and length of the appendix in Bangladeshi males. Arch Med Sci. 2013;9:55-67.	56	18-67	10.2 ± 2.5 (M)	In 62.5% of cases, the mesoappendix did not reach the end of the appendix.
Ghorbani et al.³⁷37 Ghorbani A, Forouzesh M, Kazemifar AM. Variation in anatomical position of vermiform appendix among Iranian population: an old issue which has not its importance. Anat Res Int. 2014;:313575.	200	39.3	9.1 (H)/8.0 (F)	In 79.5% of cases, there was complete mesoappendix. Incomplete mesoappendix was more observed in the 10-year-old group.
Willekens et al.¹1 Willekens I, Peeters E, Maeseneer MD, Mey J. The normal appendix on CT: does size matter?. PLoS ONE. 2014;9:e:96476.	186	61.6	8.1 ± 2.8	-
Mwachaka et al.⁴⁰40 Mwachaka P, El-Busaidy H, Sinkeet S, Ogeng’ O. Variations in the position and length of the vermiform appendix in a black kenyan population. ISRN Anat. 2014;2014:871048.	48	-	7.6 ± 2.3	-
Méndez et al.⁴¹41 Méndez PRC, Arzuaga RLG, Macadán CEF, González DL. Variantes morfométricas del apêndice cecal em el vivo. Rev Med Electrón. 2014;36:49-59.	236	28.1	9.3 ± 3.3	68.2% triangular shape and 31.7% oval shape. The most frequent insertion point was the middle third, 75.8%.
Souza et al.⁶6 Souza SC, Costa SRMR, Souza IGS. Vermiform appendix: positions and length - a study of 377 cases and literature review. J Coloproctol. 2015;35:212-6.	377	33.6	11.4	1.2% did not present mesoappendix.
Mohammad et al.⁴²42 Mohammad S, Hedjazi A, Sajjadian M, Rahmani M, Mohammadi M, Moghadam MD. Morphological variations of the vermiform appendix in Iranian cadavers: a study from developing countries. Folia Morphol. 2017;76:695-701.	693	40.6	8.0 (F)/8.6 (M)	-

Authors	n	Age (years)	Sex	Retro	Pelv	Sub	Pre-ileal	Post-ileal	Parace
Iqbal et al.⁴⁸48 Iqbal T, Amanullah A, Nawaz R. Pattern and positions of vermiform appendix in people of bannu district. Gomal J Med Sci. 2012;10:100-3.	500	1-60	M/F	57%	28.6%	-	4%	9.4%	5%
Setty e Katikireddi⁴⁷47 Setty S, Katikireddi R. Morphometric study of human cadaveric caecum and vermiform appendix. Int J Health Sci Res. 2013;3:48-55.	90	Adults/Fetuses	M/F	50%	15%	10%	-	-	-
Bakar et al.³⁹39 Bakar S, Shamim M, Ala G, Sarwar M. Negative correlation between age of subjects and length of the appendix in Bangladeshi males. Arch Med Sci. 2013;9:55-67.	56	18-67	M	53.5%	30.3%	3.5%	-	12.5%	-
Tofighi et al.²⁷27 Tofighi H, Taghadosi-nejad F, Abbaspour A, Benhoush B, Salimi A, Dabiran S, et al. The anatomical position of appendix in iranian cadavers. Int J Med Toxicol Forensic Med. 2013;3:126-30.	400	-	M/F	7%	55.8%	19%	1.5%	12.5%	-
Ghorbani et al.³⁷37 Ghorbani A, Forouzesh M, Kazemifar AM. Variation in anatomical position of vermiform appendix among Iranian population: an old issue which has not its importance. Anat Res Int. 2014;:313575.	200	-	M/F	7%	55.8%	19%	1.5%	12.5%	-
Mwachaka et al.⁴⁰40 Mwachaka P, El-Busaidy H, Sinkeet S, Ogeng’ O. Variations in the position and length of the vermiform appendix in a black kenyan population. ISRN Anat. 2014;2014:871048.	48	-	M/F	27.1%	25%	4.2%	18.8%	18.8%	2.1%
Willekens et al.¹1 Willekens I, Peeters E, Maeseneer MD, Mey J. The normal appendix on CT: does size matter?. PLoS ONE. 2014;9:e:96476.	94	27-88	M/F	7.5%	66%	-	-	12%	8.5%
Salwe et al.³⁸38 Salwe N, Kulkarni PG, Sinha RS. Study of morphological variations of vermiform appendix and caecum in cadavers of western maharashtra region. Int J Adv Physiol Allied Sci. 2014;2:31-41.	60	-	M/F	56.6%	25%	-	15%	3.3%	-
Souza et al.⁶6 Souza SC, Costa SRMR, Souza IGS. Vermiform appendix: positions and length - a study of 377 cases and literature review. J Coloproctol. 2015;35:212-6.	377	18-89	M/F	43.5%	9.3%	24.4%	2.4%	14.3%	5.8%
Rao et al.⁴³43 Rao S, Narasamma K, Shahajeer B. Vermiform appendix in adults. J Evidence Based Med Healthcare. 2015;2:2174-9.	50	Adults	M/F	66%	26%	4%	2%	2%	-
Patel e Naik ⁴⁹49 Patel S, Naik A. Anatomical variations in the positions of the vermiform appendix. IOSR-JDMS. 2016;15:106-9.	50	40-50	M/F	64%	30%	2%	-	4%	-
Mohammad et al.⁴²42 Mohammad S, Hedjazi A, Sajjadian M, Rahmani M, Mohammadi M, Moghadam MD. Morphological variations of the vermiform appendix in Iranian cadavers: a study from developing countries. Folia Morphol. 2017;76:695-701.	693	0-99	M/F	71.7%	14.7%	3.5%	1.2%	1.2%	-

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[1] *Corresponding author. E-mail: elcianavieira@yahoo.com.br (E.P. Vieira).