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Agenesis of the vermiform appendix
74
CASE REPORTS
Agenesis of the Vermif orm Appendix By M. David Tilson, M.D., and Robert J. Touloukian,
M.D.
New Haven, Conn. The rarity of agenesis of the vermiform apendix in man may occasion perplexity for the experienced surgeon who first encounters the congenital absence of this organ in the operating room. The existence of over 70 previously reported cases was brought to light by a 14-yr-old male patient, recently explored by the authors, who did not have a vermiform appendix. This patient, previously in good health, presented with a 12-yr history of periumbilical pain and vomiting. He had tenderness and involuntary muscular spasm in the right lower quadrant. The rectal examination was negative. The leukocyte count was 17,000; the urinalysis was normal. A preoperative diagnosis of acute appendicitis was made, and the abdomen was explored through a McBurney incision. The vermiform appendix was not found following a thorough and meticulous search of the entire ileo-cecal area, which included an extensive mobilization of the cecum and ascending colon with inspection of the posterior cecum. In addition, the small intestine was examined from the proximal jejunum to the ileo-cecal junction and was found to be normal. Multiple enlarged mesenteric nodes suggested the diagnosis of mesenteric lymphadenitis. The postoperative course was uncomplicated except for the development of a small wound hematoma. The appendix is fully developed in the IO-wk embryo by a pattern of differential growth rates at the base of the primitive cecum. Originally conical in shape during early fetal existence, the appendix matures by elongation to become vermiform in appearance at birth. Coincidental absence of hypoplasia of the cecum in nearly 20% of earlier cases suggests a development anomaly of the ceco-appendicular apparatus that is extremely rare and found in an estimated 0.0009% of the population. The diagnosis of agenesis of the appendix should not be made unless the ileo-cecal area and retro-cecal space are thoroughly explored. The appendix is most predictably identified by tracing the three colonic teniae to their junction at the base of the cecum. The case is reported to bring the rare entity of agenesis of the appendix to the attention of surgeons who may unexpectedly encounter a similar situation.
REFERENCES 1. Collins, D. C.: Agenesis of the vermiform appendix. Amer. J. Surg. 82:689, 1951. 2. Elias, E. G., and Hults, R.: Congenital absence of the vermiform appendix. Arch. Surg. 95:257,1967.
3. Pester, G. H.: Congenital absence of the vermiform appendix. Arch. Surg. 91:461, 1965.
CASE REPORTS
Agenesis of the Vermif orm Appendix By M. David Tilson, M.D., and Robert J. Touloukian,
M.D.
New Haven, Conn. The rarity of agenesis of the vermiform apendix in man may occasion perplexity for the experienced surgeon who first encounters the congenital absence of this organ in the operating room. The existence of over 70 previously reported cases was brought to light by a 14-yr-old male patient, recently explored by the authors, who did not have a vermiform appendix. This patient, previously in good health, presented with a 12-yr history of periumbilical pain and vomiting. He had tenderness and involuntary muscular spasm in the right lower quadrant. The rectal examination was negative. The leukocyte count was 17,000; the urinalysis was normal. A preoperative diagnosis of acute appendicitis was made, and the abdomen was explored through a McBurney incision. The vermiform appendix was not found following a thorough and meticulous search of the entire ileo-cecal area, which included an extensive mobilization of the cecum and ascending colon with inspection of the posterior cecum. In addition, the small intestine was examined from the proximal jejunum to the ileo-cecal junction and was found to be normal. Multiple enlarged mesenteric nodes suggested the diagnosis of mesenteric lymphadenitis. The postoperative course was uncomplicated except for the development of a small wound hematoma. The appendix is fully developed in the IO-wk embryo by a pattern of differential growth rates at the base of the primitive cecum. Originally conical in shape during early fetal existence, the appendix matures by elongation to become vermiform in appearance at birth. Coincidental absence of hypoplasia of the cecum in nearly 20% of earlier cases suggests a development anomaly of the ceco-appendicular apparatus that is extremely rare and found in an estimated 0.0009% of the population. The diagnosis of agenesis of the appendix should not be made unless the ileo-cecal area and retro-cecal space are thoroughly explored. The appendix is most predictably identified by tracing the three colonic teniae to their junction at the base of the cecum. The case is reported to bring the rare entity of agenesis of the appendix to the attention of surgeons who may unexpectedly encounter a similar situation.
REFERENCES 1. Collins, D. C.: Agenesis of the vermiform appendix. Amer. J. Surg. 82:689, 1951. 2. Elias, E. G., and Hults, R.: Congenital absence of the vermiform appendix. Arch. Surg. 95:257,1967.
3. Pester, G. H.: Congenital absence of the vermiform appendix. Arch. Surg. 91:461, 1965.