Anat Cell Biol.  2017 Sep;50(3):242-244. 10.5115/acb.2017.50.3.242.

Undescended cecum with accessory right colic artery: a rare case report

• Ravi PK
• Gaikwad MR
• Mishra PR
• Wakode NS
• Tripathy P
• Patro ET
• Kujur B
• Wakode SL

• KMID: 2390487
• DOI: http://doi.org/10.5115/acb.2017.50.3.242

Abstract

Midgut malrotation and incomplete rotation are common causes of neonatal intestinal obstruction. At end of 10 week of intrauterine life, cecum will be placed in subhepatic region temporarily and descends to right lower quadrant by eleventh week. Arrest of cecum in subhepatic region or undescended cecum is a rare congenital anomaly of mid gut. Usually, it remains asymptomatic and is diagnosed incidentally. If any pathology occurs in anomalous part, like appendicitis then the diagnosis and treatment will be challenging in all age groups. Variation in blood supply have also been reported with anomalies leading to iatrogenic injuries during colonoscopy and surgeries. Lack of knowledge of these rare variations may lead to delayed diagnosis of appendicitis leading to perforation and surgical emergencies. In the present case, we describe an undescended cecum and its associated variation in branching pattern of superior mesenteric artery.

Keyword

Subhepatic; Cecum; Appendicitis; Right colic artery

MeSH Terms

Appendicitis
Arteries*
Cecum*
Colic*
Colonoscopy
Delayed Diagnosis
Diagnosis
Emergencies
Humans
Intestinal Obstruction
Mesenteric Artery, Superior
Pathology

Figure

• 

  Fig. 1 (A) Photograph of subhepatic cecum: white line drawn at the level of ileocolic junction. Cecum in subhepatic location. TI A is placed intraperitoneally. (B) Subhepatic cecum is pulled up to show appendix with mesenteric extension. White line drawn at the level of ileocolic junction showing conical cecum and appendix in 12'O clock position. A, full length of vermiform appendix arising from conical cecum; C, cecum; FL, falciform ligament; J, jejunum; LL, left lobe of liver; MC, mesentric attachment of cecum; MI, mesentric extension of ileum terminal ascending part; RL, right lobe of liver; SAC, short ascending colon; TC, transverse colon; TI, terminal ileum; TI A, ascending part of terminal ileum.

• 

  Fig. 2 Blood supply to subhepatic cecum: SMA gives ICT which in turns gives IB to terminal ileum, CB, AA, and ARC. Accessory right colic artery was supplying the very small ascending colon and hepatic flexure. AA, appendicular artery; ARC, accessory right colic artery; CB, ceacal branch; IB, ileal branches; ICT, ileocolic trunk; JB, jejunal branch; MCA, middle colic artery; SMA, superior mesenteric artery.

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