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STUDY of ARTERIAL SUPPLY of CAECUM and APPENDIX: a CADAVERIC STUDY Ashwini Balasaheb Nuchhi *1, Sandhya Vikas Yatagiri 2, B G Patil 3, B M Bannur 4

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STUDY of ARTERIAL SUPPLY of CAECUM and APPENDIX: a CADAVERIC STUDY Ashwini Balasaheb Nuchhi *1, Sandhya Vikas Yatagiri 2, B G Patil 3, B M Bannur 4 International Journal of Anatomy and Research, Int J Anat Res 2017, Vol 5(3.1):4158-62. ISSN 2321-4287 Original Research Article DOI: https://dx.doi.org/10.16965/ijar.2017.272 STUDY OF ARTERIAL SUPPLY OF CAECUM AND APPENDIX: A CADAVERIC STUDY Ashwini Balasaheb Nuchhi *1, Sandhya Vikas Yatagiri 2, B G Patil 3, B M Bannur 4. *1,2 Assistant Professor, Department of Anatomy, BLDEU’s Shri B M Patil Medical College, Hospital Research centre, Vijayapura, Karnataka, India. 3 Professor, Department of Anatomy, BLDEU’s Shri B M Patil Medical College, Hospital Research centre, Vijayapura, Karnataka, India. 4 Professor and Head, Department of Anatomy, BLDEU’s Shri B M Patil Medical College, Hospital Research centre, Vijayapura, Karnataka, India. ABSTRACT Background: A precise knowledge of vascular anatomy of caecum and vermiform appendix is a must while doing surgical procedures like right hemicolectomy, appendicectomy and reconstructive microsurgeries using appendix. The aim is to study the arterial supply of the caecum and vermiform appendix, the findings of which may reveal more anatomical details including variations. Materials and Methods: 25 specimens of caecum and appendix with their arteries intact were dissected, removed from cadavers and preserved, the ileocolic artery and its branches to the caecum and vermiform appendix were traced carefully, painted with red acrylic paint and observations recorded. Results: The common caecal artery was seen in 52% of specimens. The common caecal artery which gave rise to anterior caecal artery in 40% and posterior caecal artery in 36% of specimens was the most common source of origin of these two arteries. The commonest source of origin of main appendicular artery was ileocolic artery in 28%. In 40% of specimens appendix received more than one appendicular artery. Arterial arcades were present in 12 specimens (48%) mainly between superior and inferior divisions of ileocolic artery. Conclusion: From this study we conclude that the anatomical details such as the origin, number of arteries and pattern of branching of the caecal and appendicular arteries are not only important for ablative surgeries but also in reconstructive microsurgeries using appendix for the survival of graft. KEY WORDS: arteries, caecum, appendix. Address for Correspondence: Dr. Ashwini Balasaheb Nuchhi, Assistant professor Department of Anatomy BLDEU’s Shri B M Patil Medical College, Hospital Research centre, Vijayapura-03. Karnataka, India. Mobile no 9986361044 E-Mail: [email protected] Access this Article online Quick Response code Web site: International Journal of Anatomy and Research ISSN 2321-4287 www.ijmhr.org/ijar.htm Received: 26 May 2017 Accepted: 10 Jul 2017 Peer Review: 27 May 2017 Published (O): 31 Jul 2017 DOI: 10.16965/ijar.2017.272 Revised: None Published (P): 31 Jul 2017 INTRODUCTION variationsare common and clinically significant Variation is the law of nature. Every human which create a challenge to the anatomists and being is unique to such an extent that even surgeons. identical twins are not exactly the same. Some The Ileocolic artery, lowest branch of the supe- of the variations are of considerable clinical rior mesenteric artery divides into superior and significance such as vascular ones. Vascular inferior branches. The inferior branch divides Int J Anat Res 2017, 5(3.1):4158-62. ISSN 2321-4287 4158 Ashwini Balasaheb Nuchhi et al. STUDY OF ARTERIAL SUPPLY OF CAECUM AND APPENDIX: A CADAVERIC STUDY. into- ascending colic branch, anterior caecal arterial supply of the caecum and vermiform branch supplying the anterior surface of the appendix, to determine the origin, number of caecum, posterior caecal branch supplying the arteries and pattern of branching. posterior surface of the caecum, appendicular artery supplying the appendix and ileal branch MATERIALS AND METHODS supplying terminal part of ileum [1]. The study of arterial supply of caecum and The main appendicular artery is defined as the appendix was conducted on 25 specimens of one which runs in the cresentic fold of the caecum and appendix with their arteries intact. mesoappendix to the tip of appendix giving The specimens were obtained from cadavers of numerous branches which supply whole length Department of Anatomy, BLDEU’s Shri B M Patil of appendix including its tip. The terminal part Medical College, Hospital and Research centre. of the artery lies on the wall of the appendix Vijayapur, Karnataka. and may be thrombosed in appendicitis, which results in distal gangrene or necrosis. Accessory Method of data collection: Sample size: It was appendicular artery is the one which supplies expected to consider 25 specimens of caecum other parts of the appendix except the tip. These and appendix with intact arteries. are common and many individuals possess two With proportion of variations of appendicular or more arteries of supply [2]. artery 80%[2], 20% allowable error and 95% Caeco-appendicular artery supplies base of confidence limit using the statistical formula appendix and caecal bottom [3]. The caecum and n= (1.96)2 p q/L2. Where n=sample size, appendix carries great surgical significance as p= Proportion of variations of appendicular they are affected by many pathological condi- artery = 80%, q= 100-p L= allowable error = 20%. tions such as appendicitis, ileocaecal tubercu- Methodology: The specimens of caecum, losis, carcinomas, isolated caecal infarction, appendix, part of ascending colon, terminal part angiodysplasias, varices and many more. There- of ileum and part of superior mesenteric artery fore a clear understanding of the arterial supply with ileocolic artery were separated from the of the caecum and appendix is a must for the surrounding structures after noting relation of surgeons while performing procedures like ileocolic artery and its branches. Then two appendicectomy[4], mesenteric lengthening in ligatures were applied, one on the ascending case of pouch anal anastomosis [5], therapeu- colon 20cms from the ileocaecal junction and tic embolisation in case of hemorrhage [6] and another one on the terminal ileum, 5cms from for laparoscopic surgeries [7]. the ileocaecal junction. The appendix and The vascularised appendix has been used on its caecum were removed en mass along with pedicle and subsequently in free transplant with arteries. The collected specimens were preserved success to rebuild urethra, ureters, the uterine in 5% formalin and then specimens were tubes and extra hepatic biliary tracts. The dissected, cleaned and numbered. The ileocolic precise knowledge of arterial supply of appen- artery and its branches- the anterior caecal, dix is not only important for ablation of the posterior caecal and appendicular arteries were appendix but also for various reconstructive traced and painted with red acrylic paint in microsurgeries using appendix to assure the order to make them bold and photographs were survival of whole of the transplant. At least two taken. The observations were recorded with vessels are required to ensure the whole of its regard to number, origin and branching pattern vascularisation [8]. of caecal, appendicular arteries. Superior mesenteric angiogram or ileocolic Statistical analysis: angiogram helps to diagnose carcinoma of caecum in situations where the routine investi- Data was analysed using the following statisti- gations like barium enema and colonoscopy cal methods: have missed the diagnosis and are also helpful 1) Mean +/_ standard deviation in diagnosing angiodysplasia of Caecum [9]. Hence this work has been done to study the 2) Percentages Int J Anat Res 2017, 5(3.1):4158-62. ISSN 2321-4287 4159 Ashwini Balasaheb Nuchhi et al. STUDY OF ARTERIAL SUPPLY OF CAECUM AND APPENDIX: A CADAVERIC STUDY. Fig. 1: Specimens of caecum and appendix with branches Fig.2: Specimens of caecum and appendix with branches of ileocolic artery. of ileocolic artery. Fig. 3: Specimens of caecum and appendix with branches Fig.4: Specimens of caecum and appendix with branches of ileocolic artery. of ileocolic artery. 1 – Superior mesenteric artery,2 – Ileocolic artery,3 – Superior division of Ileocolic artery,4 – Inferior division of Ileocolic artery,5 – Common caecal artery,6 – Anterior caecal artery,7 – Posterior caecal artery,8 – Main Appendicular artery,8a –Accessory Appendicular artery,8ca – Caeco-appendicular artery,9 – Ascending colic artery,10– Ileal branch,11- Right colic artery, A – Anterior view, P – Posterior view. RESULTS and main appendicular artery, in one more speci- men(8.3%) two arcades were present one be- In the present study 25 specimens were studied tween superior and inferior divisions another for the arteries supplying caecum and vermiform between two branches of common caecal artery. appendix. Table 1: ORIGIN OF COMMON CAECAL ARTERY which was Arterial arcades were present in 12 specimens present only in 13specimens (52%), as seen in Fig-2. (48%) as seen in Fig-3, out of 12 specimens Source Specimens Percentage arterial arcades were present between superior 1) Inferior division 6 46.2 and inferior divisions of ileocolic artery in 5 2) Ileocolic artery 4 30.7 3) Arterial arcade between superior specimens (42%), between two branches of 2 15.4 and inferior divisions common caecal artery in 3 specimens (25%), be- 4) Superior division 1 7.7 tween main appendicular artery and posterior Table 2: origin of anterior caecal artery. caecal artery in 1 specimen (8.3%), between Source Specimens Percentage common caecal artery and ascending colic 1)Common caecal artery 10 40 artery in 1 specimen (8.3%), in 1 specimen (8.3%) 2) Superior division 5 20 two arcades were present one between 3) Arterial arcade 5 20 4) Inferior division 2 8 common caecal artery and ascending colic 5) Ileocolic artery 2 8 artery another between ascending colic artery 6) Inferior division and common caecal 1 4 Int J Anat Res 2017, 5(3.1):4158-62. ISSN 2321-4287 4160 Ashwini Balasaheb Nuchhi et al. STUDY OF ARTERIAL SUPPLY OF CAECUM AND APPENDIX: A CADAVERIC STUDY. In the present study out of 25 specimens 18 anatomy of these arteries is an increasingly specimens had single anterior caecal artery and essential component for many therapeutic and 7 specimens had 2 anterior caecal arteries.
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