Chapter 76 The Vermiform Appendix

The importance of the vermiform appendix in surgery arises primarily from its propensity for inflammation, which results in the clinical syndrome known as acute appendicitis. The vermiform appendix is present only in humans, certain anthropoid apes and the wombat. It is a blind muscular tube with mucosal, submucosal, muscular and serosal layers. The appendix varies considerably in length and circumference. The average length is between 7.5 and 10 cm. The lumen is irregular, being encroached on by multiple longitudinal folds of mucous membrane lined by columnar cell intestinal mucosa of colonic type. Obstruction of the appendiceal lumen seems to be essential for appendiceal perforation. However, in many cases of early appendicitis, the appendix lumen is patent despite the presence of mucosal inflammation and lymphoid hyperplasia. The diagnosis of appendicitis rests more on thorough clinical examination of the abdomen than on any aspect of the history or laboratory investigation.

Multiple Choice Questions
Weblinks

Journal articles

https://www.sciencedirect.com/science/article/abs/pii/S0748798316300294?via%3Dihub/ (paid)

Early and long-term outcomes from the Basingstoke experience of more than 1000 patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for pseudomyxoma peritonei.

https://journals.lww.com/ajsp/Abstract/2016/01000/A_Consensus_for_Classification_and_Pathologic.4.aspx/ (paid)

Consensus document outlining the pathological classification of appendix neoplasia and associated pseudomyxoma peritonei.

https://www.sciencedirect.com/science/article/abs/pii/S0748798320301141?via%3Dihub/ (paid)

Clinical practice guidelines for the diagnosis and management of appendix tumours and pseudomyxoma peritonei.

https://journals.lww.com/annalsofsurgery/Abstract/2017/05000/Antibiotics_Versus_Surgical_Therapy_for.10.aspx/ (paid)

Systematic review and meta-analysis comparing antibiotics with surgery for uncomplicated appendicitis.

https://jamanetwork.com/journals/jamasurgery/fullarticle/406271/ (free)

Data from over 30 000 patients who underwent appendicectomy analysing the impact of delay in time to theatre.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517145/ (free)

Cochrane review comparing laparoscopic with open surgery for acute appendicitis.

https://www.nejm.org/doi/full/10.1056/nejmoa1110734/ (free)

Randomised clinical trial comparing low-dose computed tomography (CT) with standard dose CT in the diagnosis of acute appendicitis.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6439633/ (free)

Randomised clinical trial assessing appendix neoplasia rates in patients initially treated conservatively for appendix abscess.

https://journals.lww.com/annalsofsurgery/Abstract/2020/08000/Are_Postoperative_Intravenous_Antibiotics.57.aspx/ (paid)

Randomised clinical trial assessing the role of antibiotics following appendicectomy.

https://journals.lww.com/annalsofsurgery/Fulltext/2020/06000/Nonoperative_Treatment_Versus_Appendectomy_for.11.aspx/ (free)

Randomised clinical trial assessing non-operative treatment of uncomplicated appendicitis in children.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6953397/ (free)

Cochrane review evaluating the accuracy of computed tomography in the diagnosis of acute appendicitis.

https://academic.oup.com/bjs/article/103/1/144/6136743/ (free)

National audit from The Netherlands assessing surgical outcomes following open and laparoscopic appendicectomy.

https://journals.lww.com/clinicalobgyn/Abstract/2020/06000/Appendicitis_and_Cholecystitis_in_Pregnancy.19.aspx/ (paid)

Management of acute appendicitis in pregnancy.

Guidelines

https://boris.unibe.ch/81161/1/443165.pdf/ (free)

Consensus guidelines for the management of neuroendocrine tumours of the appendix.

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