Appendix

Appendix (lat. appendix - appendage; synonym: vermiform process, processus vermicularis, s. vermiformis) - the bone extending from the bottom of the cecum.
In embryo, 11 -12 mm (5 weeks) at the distal knee primary loop appears bulging - a rudiment of the caecum; from its initial (lagging in its growth) of the Department is formed Appendix. With the growth of the descending colon cecum gradually comes down and takes its normal position in the right iliac pit.
In very rare cases, the Appendix may be missing. Its diameter of 4-5 mm; the length of an adult varies from 1 to 15 cm, but sometimes can reach 28 cm, newborns 3-5 cm, children 10-12 years - 9,5 see old Appendix shortened, a wall it atrophies, cavity can obliteriruta.
In the Appendix wall are distinguished: the peritoneum, podbroshennye, muscle and submucosal layers, mucous membrane. In the submucosal layer A. are lymph follicles in diameter from 0,2 to 0,5 mm In A. length of 10 cm, there are up to 1500 such advances. This allows you to call A. "tonsilla appendicularis".
There are intraperitoneally located Appendix expressed bruceeckel (mesenteriolum) and nabroshena located A., sometimes half covered by the peritoneum without bruecke. Appendix often located in the center of the right iliac pits, going from the cecum top medially or down, and sometimes into the cavity, small pelvis, but can be posterior, anterior to or outward from the cecum. The same options are found and retroperitoneal location A. the Tip A. can reach the front surface of the kidney, transverse colon, gallbladder, or the right of the uterus, rectum, bladder, occasionally spleen. When retroperitoneal the location of the Appendix may lie in the tissue blind gut, in front of Parametrii, transverse colon rectum.
Projection A. on the anterior abdominal wall is most often corresponds to the point MC-Barnea (the border of the outer and middle third of a line connecting spina iliaca ant. sup. with the navel). The projection of the Appendix can also match point Monroe, i.e. the middle of the line, or point of Linander (outer edge straight muscles in linea biiliaca).
Intraperitoneally lying Appendix typically has a triangular bruecke (Fig. 1);
in the free edge are the vessels A., including lymphatic vessels along with the lymph nodes, located along the blood vessels. When the most frequent option the location of the caecum A. sometimes can be folded in the form of snails, and to lie at the bottom of the iliac-kapacitetom deepening (recessus ileocaecalis inf.). Women from A. right ovary can depart ligament (lig. appendiculoovaricum); B. C. O. Ognev for unplanned performance, it is found in 33% of cases, sometimes contains vessels. This bond is essential in the transition inflammation of the Appendix to the ovary and back. The artery supplying A. (a. appendicularis), departs from the iliac-colon artery (A. ileocolica); it may be main, loose or loop-like types (Fig. 2), which is of great importance in appendectomy for the right blend ligatures and prevention of bleeding. Vienna A. v. appendicularis) belongs to the system of upper mesenteric vein and reproduces artery of the same name. Interned iliac-kapaciteta region (regio ileocaecalis) and A. from the top mesenteric sympathetic plexus.
Appendix as "tonsilla appendicularis" give quick response from follicular unit in violation of the functions of a blind gut, especially in the inflammatory processes of different origin. Inflammation A. - see Appendix. Parasites Appendix. In A. can inhabit different parasites: Balantidium coli, Entamoeba histolytica (in the last case it is possible amoebic appendicitis), but more often - various parasitic worms in the first place pinworms. According to statistics, various researchers, half of all bungs, istechenii during the operation, they found not only young pinworms, but Mature females, genital which were filled with eggs. Vlasoglav in A. less common pinworms; occasionally fall A. tsepni and roundworm. Parasitic worms Appendix in many cases cause pathological changes in the body of the owner. Irritating substances, emitted by mass pinworms cause sudden blood mucosa process and its inflammation. In addition, pinworms, prikazivati to the walls or getting into the crypt, violate the integrity of the mucous membrane and the open access to the inside of the pathogenic microflora, which can lead to the development of appendicitis. Similar action has and vlasoglav penetrate into the thickness of the mucous membrane of thin head end and also in breach of its integrity.
Tumor A. - see Carcinoid, Intestine (tumors).

Fig. 1. The blood vessels of bruecke and the walls of the vermiform process.
Fig. 2. The main options of building a. appendicularis: 1 - main; 2 - loose; 3 - loop-like.