Also called as vermix, vermiform appendix is a narrow vermin (worm shaped) tube arising from the posteromedial aspect

of the cecum (a large blind sac forming the commencement of the large intestine) about 1 inch below the iliocecal valve. Small lumen of appendix opens into the cecum and the orifice is guarded by a fold of mucous membrane known as valve of Gerlach. The 3 taenia coli (taenia libera, taenia mesocoli and taenia omental) of the ascending colon and caecum converge on the base of the appendix. Although the appendix serves no digestive function, it is thought to be a vestigial remnant of an organ that was functional in human ancestors. The length varies from 2 to 20 cm with an average of 9 cm with diameter of about 5mm. It is longer in children compared to adults. In the fetus it is a direct outpouching of the caecum, but differential overgrowth of the lateral caecal wall results in its medial displacement. The appendix is suspended by a small traignular fold of peritoneum, called the mesoappendix.

Arterial Supply: 1. Appendicular artery: The mesoappendix, containing the appendicular branch of the ileocolic artery (branch of superior mesenteric artery), descends behind the ileum. 2. Accessory appendicular artery: An accessory appendicular artery can branch from the posterior cecal artery which is also a branch of ileocolic artery. Venous drainage: Appendicular vein > Ileocolic vein > Superior mesenteric vein > Portal vein Lymphatic drainage: There is abundant lymphoid tissue in its walls. From the body and apex of the appendix 8-15 vessels ascend in the mesoappendix and are ocasionally interrupted by one or more nodes > unite to form 3 or 4 larger vessels > inferior and superior ileocolic nodes A few of them pass indirectly through the appendicular nodes situated in the mesoappendix.

Nerve supply: 1. Sympathetic nerves: T9 and T10 spinal segments through the celiac plexus 2. Parasympathetic nerves: Vagus

Histology: Inside to outside 1. Mucosa: No villi Epithelium invaginates to form crypts of Liberkuhn but the crypts do not occur as frequently as in the colon Muscularis mucosae is ill defined 2. Submucosa:

Large accumulations of lymphoid tissue in the lamina propria and submucosa. Hence appendix is also called abdominal tonsil. There is often fatty tissue in the submucosa. 3. Muscularis externa:

Thinner than in the remainder of the large intestine Comprises 2 layers: Inner circular muscle layer and Outer longitudinal muscle layer Outer longitudinal smooth muscle layer does not aggregate into taenia coli 4. Serosa and peritoneum