Vermiform Appendix - What is it?, position, R.I.F, Management

VermiformWarm like the length - 7.5 cm to 10 cm, muscular coat resembles that of the small intestine. In the submucous coat a large number of lymphoid follicles are present. That is why it is called Abdominal tonsil

Vermiform Appendix

The appendicular artery branch of the Ileo-colic artery is an end artery. An accessory appendicular artery may be present at the base branch of the caecal artery.

Mesoappendix: Fatty structure which springs from the lower surface of the mesentery and contains the appendicular vessels.

Inconsistency of position:
Retro-caecal - 74%
Pelvic - 21%
Para-caecal - 2%
Sub-caecal - 15%
Pre-Ileac - 1%
Post-Ileac - 0.5%
It must share in abnormalities in the position of the caecum.
Sub-hepatic - failure of descending of caecum.
Left-Hypochondrium - Arrested rotation of gut.
Left Iliac fossa - Situs Inversus of visceral.
Absence of vermiform appendix - 1 in 1,00,000.
Rarely double appendix.

Common causes of a lump in Right Iliac fossa (R.I.F)
Appendicular lump
Appendicular abscess
Ileocecal Koch's
Crohn's disease
Carcinoma caecum
Iliac lymphadenopathy
Psoas abscess
Pelvic kidney
Undescended testis 
Amoebic Typhilitis
Tubo-ovarian mass
Mucocele gall bladder
Chordoma or chondrosarcoma of Ilia bone.

Managements of Appendix mass (Vermiform appendix)
If a patient with an appendicular lump, the condition of the patient is satisfactory the standard modern treatment is conservative. Native has already localized the lesion and it is foolish to disturb this barrier. Surgery at this time is difficult, bloody, and dangerous. A rigid nonoperative program is followed but to prepared to operate at any time should nature fail to control the infection.
  1. The treatment should be undertaken in a hospital.
  2. The physical signs are recorded in the clinical notes.
  3. The lump is drawn by a skin marking pencil.

Charts: Pulse hourly and the temperature every 4 hours. Unless vomiting is a small quantity of clear fluid a nasogastric aspiration tube is passed to keep the stomach empty.

Diet: If no vomiting water 30ml hourly. Mouthwashes are given frequently. Desire for food usually about the 4th or 5th day is an indication for satisfactory progress and oral feeding may be started.
Intravenous fluid: According to fluid balance chart and electrolytes assay.

Drugs: Sedatives, analgesics, and antibiotics.
Parenteral ampicillin, gentamycin, and metronidazole are given.
Where oral feeding started, oral medicines are given.

Bowel: On the 4th or 5th-day glycerin suppository will encourage bowel evacuation.
Daily examination of abdominal rigidity, tenderness, and size of the lump.

Interval appendicectomy: Appendicectomy advised after 6 - 8weeks.

Interruption of conservation treatment: Increased pulse rate, temperature, abdominal rigidity, and vomiting, the urgent operation is indicated. 


Post a Comment

Previous Post Next Post