A Case Series on Variations in Location of Vermiform Appendix: Revisited with Computed Tomography

Abstract

The appendix is known to have varying locations and extents in relation to the cecum, to which it is attached in the main gastrointestinal tract. These variations have significant implications in terms of the varying clinical presentation of appendicitis, which may deviate from the classical presentation in the right iliac fossa and thus delay diagnosis. Knowledge of the different positions of the appendix helps in identifying the relatively common pathology of appendicitis, which may occur even beyond the confines of the right iliac fossa. This imaging case series depicts the spectrum of variations in the locations of the appendix as seen on Computed Tomography (CT) in a comprehensive though simpler way. The types of appendix illustrated in this imaging case series include the medial appendix with its subtypes (postileal-3, pelvic-2), subcecal (3), retrocecal (2), paracecal (1), and prececal appendix (1). In cases of the acute abdomen where appendicitis is suspected and if the appendix is not identified or only partly traced in the right iliac fossa, attempts should be made to trace the entire appendix in unconventional locations in the abdomenpelvis. Such a scenario might be more likely if the patient is only experiencing distal appendicitis.