Module: Vermiform Appendix Dissection

The purpose of this module is to ensure all appendix specimens are described and dissected properly so that a diagnosis can be issued. Please refer to local standard operating procedures (SOP) for complete details.

(NOTE: You can view 3D models in larger format by clicking on the "fullscreen" icon at the bottom right.)

Specimen Handling Objectives

The learner is expected to apply some elements of the content learned in part 1 in the grossing of the simulation specimens.

Note: If the learner is unsure of the next steps during the simulation workshop, they should ask questions and/or seek help.

After reviewing the relevant readings, images, SOPs and finishing the Introduction to Grossing Workshop, the learner will:

Select and wear the appropriate PPE for the grossing of the simulation specimens
Set up an organized grossing bench for the grossing of simulation specimens
Confirm patient identification, specimen type, and alpha designation for the specimen and matched cassettes
Read the provided clinical history
Orientate an appendix, identifying the proximal margin, distal tip, and serosa and differentiate the appendix from the mesoappendix.
Describe the steps for grossing an appendix AP04-3.06 Appendix (labqms.com)
Observe simulated demonstration
Gross a simulated appendix using the appendix SOP and appendix template Grossing Templates AP04-1.03 Grossing Templates (labqms.com)
Select the correct processing time for an appendix
Demonstrate the safe setup, cleaning and discard of sharps (scalpel and feather blades)
Clean the grossing bench between specimens and apply steps to limit cross-contamination between specimens
Determine when they are unsure of the next steps and ask questions/seek help

Learning Material

Appendix SOP AP04-3.06 Appendix (labqms.com)
Grossing Templates AP04-1.03 Grossing Templates (labqms.com)
AP04-1.01 Dissection Guidelines AP04-1.01 Dissection Guidelines (labqms.com)

Anatomy

(see collapsable images on the right)

Appendix (also vermiform appendix) is a finger-like, hollow, blind-ended tube connected to the cecum, typically located in the right lower quadrant. It has a large aggregation of lymphoid tissue and is suspended from the terminal ileum by mesoappendix. The mesoappendix contains appendiceal vessels, including the appendicular artery, a branch of the ileocolic artery.

The point of attachment to the cecum can be identified by the highly visible free taeniae coli leading to the base of the appendix. The location of the appendix can vary significantly and may be located freely suspended within the abdominal cavity, behind the cecum (retrocecal), or anterior (pre-ileal) or posterior (post-ileal) to the terminal ileum. As an intraperitoneal organ, the appendix and mesoappendix are covered by a serosal surface.

Indications for Surgery

Vermiform appendices are generally removed due to the clinical presentation of acute appendicitis. They can also be included as part of other surgeries, such as right hemicolectomy. An appendix can also be removed during surgery for ovarian neoplasms.

3D Model (Textured)

3D model provides an anatomic representation of a typical appendicectomy specimen

Regions of interest for orientation and inking include:

Appendix resection margin
Mesoappendix
Mesoappendix margin
Appendiceal tip

The appendix resection margin is inked according to SOP as follows:

Appendix margin - Blue

(if the appendix is dilated, raising consideration of mucinous neoplasm (or included clinical history)- ink the entire serosal surface)

Appendix Dissection 3D Diagram

Complete gross description in accordance with SOP. Record dimensions, colour, and observation of external surfaces
Ink appendix margin (blue)
Amputate the appendix tip (1.5-2.0 cm) and bisect longitudinally to fit into the cassette
Cut the appendix transversely in 0.3 cm intervals

3D diagram demonstrates the approximate configuration of cuts.

Example of Inflamed Appendix (3D)

Appendix example that shows typical features of acute appendicitis

Mildly dilated and congested appendix
Congested serosal vasculature
Purulent serosal exudate

Perforation not identified

Note staple margin present on appendix base (typically inked blue) and mesoappendix

Page updated

Report abuse