Anomalias congênitas e variações anatômicas do apêndice vermiforme e mesoapêndice

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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Sumário

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

Anomalias congênitas e variações anatômicas do apêndice vermiforme e mesoapêndice

Autoria SCIMAGO INSTITUTIONS RANKINGS

RESUMO

Objetivo:

O objetivo desta revisão foi apresentar e discutir as variações anatômicas e anomalias congênitas do apêndice vermiforme e mesoapêndice relatados nos últimos anos e suas associações com apendicite aguda e outras patologias associadas.

Métodos:

A busca foi realizada nas seguintes bases de dados: Pubmed, Science Direct e Scielo.

Resultados:

Trinta e sete estudos foram incluídos nesta revisão. Entre as anormalidades do apêndice vermiforme identificada estão agenesia e duplicidade e, variações anatômicas relacionadas ao comprimento e posicionamento. A duplicidade apendicular foi a anormalidade mais incidente, principalmente do Tipo B2, associada à apendicite aguda, seguida de agenesia do Tipo III. O primeiro caso de agenesia associada à apendicite aguda e à duplicidade de apêndice do tipo vólvulo foi identificado. A posição mais frequente foi a retrocecal em adultos e a pélvica em crianças. No mesoapêndice, foram identificadas variações anatômicas em seu posicionamento, formato, ausência e comprimento.

Conclusão:

Esta revisão procurou apresentar e discutir as variações anatômicas e anomalias congênitas do apêndice vermiforme e mesoapêndice relatados nos últimos anos e suas associações com apendicite aguda e outras patologias associadas contribuindo para o auxílio no diagnóstico clínico e intervenções cirúrgicas em pacientes com suspeita apendicite aguda.

Palavras-chave:
Apêndice vermiforme; Variação anatômica; Anomalias congênitas

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).