CAECUM AND APPENDIX ABDOMEN

1. THE CAECUM
Dr Vinay KVS
MBBS, MD, PGCD,
PGDBEME.
bhushetty102@gmail.com

2. GENERAL FEATURES
 Commencement of
large intestine
 Asymmetrical cul-
de-sac
 Furnished with
taeniae coli
 Lies in the right iliac
fossa
 Length- 6cm
 Breadth- 7.5cm

3. TYPES
DEPENDING ON THE SHAPE

4. POSITION
 Normally right iliac
fossa
 Occupies a
triangular area
 Due to faulty
rotation may
occupy any other
abnormal location

5. ABNORMAL LOCATIONS
 Left iliac
fossa
 Umbilical
region
 Subhepatic
 Right
lumbar
 Pouch of
Douglas

6. RELATIONS
 Peritoneal- all sides
covered by
peritoneum
 General-
Above- continuous
with ascending colon
Below- rests on
inguinal ligament
Anteriorly-anterior
abdominal wall,
Greater omentum,
coils of intestine.

7. RELATIONS
 Posteriorly
 Right Ilio-
psoas
 Lateral
femoral
cutaneous
nerve
 Femoral
nerve
 Genito-
femoral
nerve
 Retro-caecal
recess of
peritoneum

8. BLOOD SUPPLY
 Arterial supply
 Anterior and
posterior caecal
branches of
inferior division of
ileocolic artery
 Venous drainage
 Ileocolic vein and
thence into
superior
mesenteric vein

9.  NS:
 Sym: T11 to L1.
 PS: Vagus N.

10. INTERNAL FEATURES
 Ileo-caecal orifice
 Measures 2.5 cm
 Situated in the
posteromedial wall
of caecum
 Guarded by valve
having upper and
lower lip
 Lips meet and
continue as
mucous folds
known as frenula

11. APPENDICULAR ORIFICE
 Small circular
opening
 2cm below and
behind the ileo-
caecal orifice
 Guarded by valve
of Gerlach

12. CLINICAL ANATOMY
 Acts as a guide in operation of intestinal
obstruction.
 Intussusception- telescopical invagination of
terminal part of ileum into the caecum and
ascending colon.

13. THE VERMIFORM
APPENDIX

14. GENERAL FEATURES
 Worm like narrow
tubular diverticulum
 Arises from
posteromedial wall of
the caecum, 2cm
below the ileo-caecal
junction
 Suspended by
mesoappendix
 Devoid of taenia coli,
sacculations,
appendices epiploicae
 2-20 cm in length

15. SURFACE ANATOMY
 Base of
appendix
 McBurney’s
point

16. PRESENTING PARTS
 Base
 Body
 Tip
 Mesoappendix

17. TYPES
 Retro-
caecal
 Pelvic type
 Sub-caecal
 Promonteri
c
 Mid-
inguinal
 Splenic
type
 Pre-ileal
 Post-ileal

18. ARTERIAL SUPPLY  Appendicular artery,
a branch of inferior
division of ileocolic
artery
 End artery
 Tip least vascular
 Veins drain into
SMV

19.  NS:
 Symp: T9 to T10 through coeliac plexus.
 PS: Vagus.
 Referred pain from appendix is felt at Umbilicus,
similat to pain of small intestine and testis.
 LD: Ileocolic Lymph Nodes.

20. CLINICAL ANATOMY
 Inflammation of appendix known as appendicitis
 Pain, vomiting, temperature
 Pain first felt in umbilical region, then settles in right
iliac fossa
 Local peritonotis
 Tenderness and rigidity