Fig' 137- Vermiform Appendix and Caecum. 



In a robust male corpse, a lozenge-shaped window has been made 5 inches 

 by 4 inches throttgh the skin but of a smaller area through the deeper layers 

 of the right Hypogastric and Iliac Regions; Omentum and Transverse Colon 



are tlirowii upwards. 



The Appendix is at a higher level, and more laterall}^ situated than usual; 

 its position varies with the degree of distension of the neighbouring intestines. 

 As the Appendix is completely enveloped in Peritoneum, its mobility is very 

 marked in contrast to the commencement of the Ascending Colon which is only 

 covered anteriorly whereas posteriorly it remains fixed to the posterior abdominal 

 wall (cf. Fig. 136). 



The Caecum, usually 2^/r,ths inch long, is situated in the Right Iliac 

 Fossa on the Fascia Iliaca above the outer V2 of PouPART's Ligament; when 

 moderately distended and the neighbouring coils of intestine empty or only 

 slightly distended it lies against the Anterior Abdominal Wall, but if more 

 movable it ma}- lie bent upwards upon the Ascending Colon. 



Coming off the lower end of the Caecum near the Ileo-Caecal Junction and 

 in possession of its own mesentery the position of the Vermiform Appendix is 

 very variable; in length it varies from i to 10 inches (usual length 3 to 4 inches); 

 in shape it may be straight, serpiginous, spiral or bent upon itself; in position it 

 may come in contact with the Bladder or Ovary in the true Pelvis, it may lie 

 behind the Ileum or extend up behind the Caecum, Kidney or even the Liver, 

 or Stomach, and extending beyond the middle line. 



Its base corresponds to Mc BuRNEY's point — midway between the 

 right Anterior Superior Iliac Spine and the LTmbilicus. 



The Arteries to tlie Ileum, Caecum and Appendix produce folds of Peri- 

 toneum in relation with which small recesses are formed, e. g. Superior and 

 Inferior Ileo-Caecal Fossae. 



As Appendicitis is of frequent occurrence, operations upon the Vermiform 

 Appendix are often necessary. The usual incision is made directly above and 

 parallel to the outer V2 of PoUPARX's Ligament; — though the viscus can be 

 reached by an incision along the outer border of the Rectus Abdominis Muscle 

 at the level of the Anterior Superior Iliac Spine. 



