CT guided appendicectomy incision: A prospective case series

Abstract

Objective: Several radiological studies have suggested that the base of the Appendix often does not correspond with Mc Burney's point. The aim of our study is to assess the value of using CT localization of the appendicocaecal junction to guide placement of the appendicectomy incision.

Design & method: 32 consecutive patients, booked for open appendicectomy were prospectively included in this study. Coronal and axial CT scans with IV contrast were studied to assess site of the appendicocaecal junction. This information was used to guide placement of the incision.

Results: 28 out of 32 patients studied, the appendicocaecal junctions were accurately identified. It was noted that the final incision sites were cephalad to Mc Burney's point in 8, at the point in 3 and caudal in 17. In 1 patient, it was necessary to extend the incision medially by 2cm to retrieve the distal Appendix which had been detached through the site of rupture.

Conclusion: Mc Burney's point often does not correspond to the base of the appendix. We propose that using CT imaging to guide the appendicectomy incision is safe, facilitates locating the Appendix at surgery, minimizes incision size and decreases the need to extend it.

Keywords: Appendicectomy incision; Appendicitis; Mc Burney's point.

Fig. 1

a) Axial CT scan with IV contrast showing the appendico-caecal junction (arrow), a thickened Appendix with enhancing walls, periappendiceal fat stranding and an appendicolith (Curved arrow). Extraluminal air is also present (arrowhead). b) Coronal CT scan with IV contrast showing a thickened Appendix with enhancing walls and periappendiceal fat stranding. The appendico-caecal junction (white arrow) is just superior and medial to the right anterior superior iliac spine measuring below the calculated McBurney’s point (X). c) Showing the incision site marked on the skin with indelible ink, caudal to the calculated McBurney’s point (X).

Fig. 2

a) Axial CT scan with IV contrast showing an appendicolith (straight arrow) at the appendico-caecal junction at the level of the superior aspect of the umbilicus (dashed arrow). b) Showing the incision site cephalad to the calculated McBurney’s point (X).

Fig. 3

a) Axial CT scan with IV contrast showing the appendico-caecal junction (arrow), a thickened Appendix with enhancing walls. b) Coronal CT scan showing a thickened appendix (arrow) with enhancing walls, peri-appendiceal fat stranding and two appendicoliths. The base of the Appendix is seen at McBurney's point. c) Showing the skin incision at the calculated McBurney’s point (X).

Fig. 4

a The appendicocaecal junction, with a faecolith (arrow), lies well below and medial to McBurney's point (X). b) The appendicocaecal junction lies low in the pelvis (arrow). c) Small incision placed well below McBurney's point successfully locates the base of the appendix.