Morphology and Morphometry of the Vermiform Appendix in Kashmiri Population: A Cross-Sectional Contrast Computed Tomography (CT)-Based Study.

Javed Ahmad Khan; Baseerat Rashid Kaboo; Naseer Ahmad Khan; Reyhana Yousuf; Sajad Hamid; Sheikh Aakida Hussain

doi:10.51168/97jaef26

Authors

Dr Javed Ahmad Khan Associate Professor, Department of Anatomy, Government Medical College, Srinagar, Jammu and Kashmir, India.
Dr Baseerat Rashid Kaboo Associate Professor, Department of Radiodiagnosis, Government Medical College, Srinagar, Jammu and Kashmir, India.
Dr Naseer Ahmad Khan Associate Professor, Department of Radiodiagnosis, Government Medical College, Srinagar, Jammu and Kashmir, India.
Reyhana Yousuf Senior Resident, Department of Anatomy, Kashmir Medical College, Jammu and Kashmir, India.
Dr Sajad Hamid Associate Professor, Department of Anatomy, SKIMS Medical College, Srinagar, Jammu and Kashmir, India.
Dr Sheikh Aakida Hussain Post Graduate Scholar, Department of Anatomy, Government Medical College, Srinagar, Jammu and Kashmir, India.

DOI:

https://doi.org/10.51168/97jaef26

Keywords:

Appendix, Normal Anatomy, Computed Tomography, Population Anatomy, Appendicitis Diagnosis, Surgical Reference

Abstract

Background

Diagnosis of acute appendicitis on contrast-enhanced computed tomography (CT) relies heavily on a 6 mm appendiceal diameter threshold derived largely from Western populations. Population-specific anatomical reference data for Kashmiri adults are lacking, raising the possibility that this threshold may not translate accurately to this population.

Methods

A cross-sectional, prospective observational study was conducted in the Department of Radiodiagnosis, Government Medical College, Srinagar, over one month (1–31 March 2024). Using consecutive sampling, 100 contrast-enhanced abdominal CT scans of asymptomatic adults (≥18 years) imaged for indications unrelated to the appendix were included; individuals with prior appendicitis, right iliac fossa surgery, or CT evidence of appendiceal pathology were excluded. Appendiceal position, length, and width at the base, midpoint, and tip were measured on PACS workstations, with 20% re-measured independently for reliability. Data were analysed in SPSS version 26.0 using descriptive statistics.

Results

Participants had a mean age of 34.6 ± 12.3 years (range 18–65 years) with a near-equal male-to-female ratio (58:42). The appendix was most frequently retrocecal (33%), followed by preileal (22%), postileal (19%), subcecal (13%), paracecal (8%), and pelvic (5%) positions. Mean appendiceal length was 5.4 ± 0.6 cm (range 4.2–6.6 cm). Mean width was 7.2 ± 0.3 mm at the base (range 6.7–7.8 mm), tapering to 6.5 ± 0.5 mm at the midpoint and 6.0 ± 0.8 mm at the tip. A basal width exceeding the conventional 6 mm threshold was observed in 41% of asymptomatic individuals.

Conclusion

Kashmiri adults may possess a naturally larger appendiceal caliber than currently accepted international norms, and rigid application of the 6 mm threshold risks overdiagnosis of appendicitis in this population.

Recommendation

Population-specific reference ranges are recommended for appendiceal diameter, with diagnostic emphasis placed on secondary CT signs of inflammation rather than diameter alone, particularly in borderline cases.

Author Biographies

Dr Javed Ahmad Khan, Associate Professor, Department of Anatomy, Government Medical College, Srinagar, Jammu and Kashmir, India.

is an Associate Professor in the Department of Anatomy, Government Medical College, Srinagar, with a research interest in clinical and radiological anatomy.
Dr Baseerat Rashid Kaboo, Associate Professor, Department of Radiodiagnosis, Government Medical College, Srinagar, Jammu and Kashmir, India.

is a Senior Resident in the Department of Anatomy, Government Medical College Baramulla, with an interest in gross and applied anatomy.
Dr Naseer Ahmad Khan, Associate Professor, Department of Radiodiagnosis, Government Medical College, Srinagar, Jammu and Kashmir, India.

is an Associate Professor in the Department of Radiodiagnosis, Government Medical College, Srinagar, specialising in abdominal and cross-sectional imaging.
Reyhana Yousuf, Senior Resident, Department of Anatomy, Kashmir Medical College, Jammu and Kashmir, India.

is a Senior Resident in the Department of Anatomy, Kashmir Medical College, with research interests in morphometric and imaging-based anatomical studies.
Dr Sajad Hamid, Associate Professor, Department of Anatomy, SKIMS Medical College, Srinagar, Jammu and Kashmir, India.

is an Associate Professor in the Department of Anatomy, Skims Medical College, Srinagar, with an interest in applied and surgical anatomy.
Dr Sheikh Aakida Hussain, Post Graduate Scholar, Department of Anatomy, Government Medical College, Srinagar, Jammu and Kashmir, India.

is a Postgraduate Scholar in the Department of Anatomy, Government Medical College, Srinagar, involved in anatomical and imaging-based research.

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