SYNOPSIS
PG Dissertation
RGUHS Bangalore
Proforma for registration of subjects for dissertation
1. Name of the candidate and Address: / DR. MANASI MRUTHYUNJAYANo.128,3rd MAIN,5th CROSS
VINAYAKA LAYOUT, BOOPSANDRA
BANGALORE-560094
2. Name of the Institution: / Sri Dharmasthala Manjunatheshwara College of Medical Sciences and Hospital, Sattur, Dharwad.
3. Course of study and subject: / MD ANATOMY
4. Date of admission to the course: / May 3rd 2010
5. Title of the topic: / Vermiform Appendix –Variations in position, length, and arterial supply with clinical relevance.
6. Brief resume of intended work
6.1 Need for the study: / Appendicitis is the most common acute surgical condition of the abdomen .Appendectomy for appendicitis is the most commonly performed emergency operation in the world. The lifetime rate of appendectomy is 12% for men and 25%for women, with approximately 7% of all people undergoing appendectomy for acute appendicitis during their lifetime.
Anatomically, the position of the appendix can vary with respect to the caecum and can be retrocaecal, paracolic, preileal, postileal, pelvic or subcaecal. Anatomic variations in the position of the inflamed appendix lead to deviations in the usual physical findings. Hence knowledge of these variations is essential for accurate diagnosis and treatment of the condition Identification of the normal position of the appendix is important because in appendicitis, variable positions may produce symptoms and signs related to their position and hence can mimic other diseases. Inflammation of atypically located appendix may initiate inflammation of other organs which leads to diagnostic errors and life threatening complications. Hence such a study is needed to improve the diagnostic and therapeutic ability of surgeons.
6.2 Review of literature: / A descriptive study by Paul UK et al was undertaken where in 60 human postmortem vermiform appendices were studied, age ranging from 0 to 65from January 2006 to June 2007. The study showed that retrocaecal position was the highest(65%) followed by pelvic(31.7%) and post ileal(3.3%).Subcaecal and pre ileal varieties were not found1.
A cross sectional descriptive study by Rahman MM et al on 100 cadavers of different age and sex during postmortem examination revealed that pelvic position was the commonest in 47%cases.The retrocaecal was the second highest(22%) and pre ileal was the lowest(10%).In respect to sex,incidence of pelvic variety of vermiform appendix were more in male than female2 .
A cross sectional study was done by Golalipour MJ et al on 117 patients who had undergone appendicectomy. The average length of appendix was 6.61cm in males and 6.06cms in females. Pelvic position was the predominant position(33.3%)followed by retrocaecal in 32.4%,preileal in 18.8% and subcaecal in 12.8% respectively3.
A study carried out by Delic J et al in open appendectomy cases revealed that the vermiform appendix is placed in the pelvic position in 57.71% cases and paracaecal in 3.07% cases4.
The arterial blood supply, position and length of appendix were studied in 100 Indian cadavers by Ajmani ML and Ajmani K. In 39%more than one appendicular artery was demonstrated. The retrocaecal and retrocolic positions were the commonest(58%) followed by postileal position(10%). The average length of the appendix was found to be 9.5 cm in male and 8.7cm in female5.
The arterial blood supply,position and length of the appendix were studied in 103 Zambian cadavers by Katzurskj MM et al.In 39.8%,more than one appendicular artery was found. In position 43.6% were pelvic and 20.3% retrocaecal.The average length of the appendix was 12 cms in males and 11.4cm in females6.
6.3 Objectives of study: / 1 To study the variations in position of vermiform appendix in cadavers and intraoperative cases by categorizing the specimen into paracolic, retrocaecal, subcaecal, pelvic, preileal or postileal types.
2 To study the distribution in length of the appendix in cadavers.
3 To note the arterial supply of the appendix in cadavers and intraoperative cases and to identify any variations in blood supply.
7. Material and Methods
7.1 Source of Data / 1 Cadavers
2 Patients undergoing abdominal surgery
7.2 Method of collection of data / Cadavers allotted to MBBS students will be selected from medical colleges in the North Karnataka region. Both male and female cadavers will be included in the study. Each cadaver will be dissected by making a midline incision on the abdomen and reflecting the flaps.
The vermiform appendix will be located by following the anterior taenia coli and its position will be determined. Based on position the appendix will be categorized into retrocaecal, pelvic, preileal, postileal, or paracolic groups.
The length of the appendix from the base to the tip will be measured using measuring tape and the values will be recorded. The arterial supply of the appendix will be made note of. Presence of any accessory appendicular arteries will be recorded. Photographs will be taken of cadaveric appendix specimens.
Patients undergoing abdominal surgery including appendicectomy will be identified and the appendix in such cases will be photographed. The position of the appendix in the living will be identified and recorded. The arterial supply will be studied.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals. If so please describe briefly / No
7.4 Has ethical clearance been obtained from your institution in case of 7.3? / Yes clearance from Ethical Committee SDM College of Medical Sciences and Hospital has been taken.
8. List of references: / 1. Paul UK et al.Position of Vermiform Appendix: A Postmortem Study. Bangladesh J Anat January 2009;Vol 7 No 1 pp 34-36
2. Rahman MM et al.Anatomical Positions of Vermiform Appendix in Bangladeshi People. J Bangladesh Soc Physiol.2006 Dec;(1):5-9
3. Golalipour MJ et al. Anatomical Variations Of Vermiform Appendix in South-East Caspian Sea(Gorgan-Iran).J Anatomical Society of India 2003;Vol 52,No 2
4. Delic J, Savkovic A, Isakovic E.Variation in the position and point of origin of the Vermiform appendix. Med Art.2002;56(1):5-8
5. AjmaniML, Ajmani K. The position,length and arterial supply of vermiform appendix. Anatomischer anzeiger.1983; 153(4):369-374
6. Katzurskj MM, GopalRao UK,Brady K.Blood supply and position of the vermiform appendix in Zambians. Medical Journal of Zambia.1979;13(2):32-34
9. Signature of the Candidate:
10. Remarks of the Guide: / Necessary for surgeons in clinical approach and also for anatomist for study and description purpose
11. Name and Designation of 11.1Guide: / Dr M.N Kulkarni
Professor,
Dept of Anatomy,
SDM College of Medical Sciences and Hospital, Sattur, Dharwad
11.2Signature :
11.3Co Guide:-Nil-
11.4Signature :-Nil-
11.5 Head of the Department: / Dr Ramachandra N Kalghatgi,
Professor and Head,
Dept of Anatomy,
SDM College of Medical Sciences and Hospital, Sattur , Dharwad
11.6 Signature :
12.1Remarks of the chairman and Principal:
12.2Signature :