Large Caliber Appendicular Artery Masquerading As Ureter in Retrocolic Appendicitis: A Series

Jagpreet S Deed, MS, DNB, MRCS, Gen, Surg¹, Zaki Kamal, Urology¹, Vinay Sabharwal, MS, Gen, Surg², Parveen Bhatia, MS, FRCS, FICS, FIAGES, FMAS, FAIS, FALS³, Vivek Bindal, MRCS, Fellowship, , MAS, Endoscopy, FNB⁴. ¹Zulekha hospital, Sharjah, UAE, ²Jeewan Mala Hospital, ³SIr Ganga Ram Hospital and Bhatia Global hospital and Endosurgery Institute, ⁴SIr Ganga Ram Hospital

Introduction: The retrocolic appendix occupies usual retrocaecal position, followed by course- posterior to ascending colon, for a variable length till liver. Its supplying vessels are also buried retro-peritoneally and when significantly large in calibre, the appendicular vessels may mimic other important structures like ureter or gonadal vessels, which are present in similar position.

Objectives:

• To demonstrate the existence of large caliber appendicular vessels mimicking ureter in a series of laparoscopic retrocolic appendectomies and difficulties while managing mesoappendix in such cases.
• To compare such cases with routine laparoscopic appendectomy.

Methods and procedures: Records of all laparoscopic retrocolic appendectomy were searched and their videos were reviewed. Their age group, operative time and BMI were compared with those of laparoscopic appendectomy for routine cases.

Results: Since 2008, 7 cases of laparoscopic retrocolic appendectomy were performed. Such cases were more commonly found in pediatric population (mean age of occurrence at 8.16, as compared to 34.3 for routine cases) and their BMI was lower (21.9 versus 27.3). Operative time was more for laparoscopic retrocolic appendectomy (62.7 minutes versus 35.5minutes) than routine cases, though after gaining familiarity with anatomy following initial cases, the operative times shortened.

Conclusions: Appendectomy can be challenging procedure demanding awareness of anatomical variations. Laparoscopic appendectomy for retrocolic appendix can be a technically demanding and its vasculature can cause dilemma due to large caliber of vessels. Familiarity with such cases allows surgeon to proceed more smoothly with reasonable operative time.