Annals of the Royal College of Surgeons of England (1990) vol. 72, 304-308
McBurney's Omar M Karim
point fact or fiction? FRCS
Registrar, Academic Unit of Surgery
Anne E Boothroyd
FRCR
Senior Registrar, Department of Radiology
John H Wyllie
FRCS
Professor of Surgery
Whittington Hospital, London
Key words: Appendix; Caecum; Barium
enema
Anthropometric measurements were performed on 51 normal, supine, barium enema examinations to determine the position of the lower pole of the caecum and the base of the appendix relative to palpable bony landmarks (the anterior superior iliac spine and the symphysis pubis). Four quadrants were defined (iliac, umbilical, inguinal and pelvic) by the intersection of the right lateral line and the interspinous line (the line joining the left and right anterior superior iliac spines). The position of the lower pole of the caecum was iliac in 12%, inguinal in 37%, and pelvic in 51%. The appendix or appendix stump was visualised on 53% of the barium examinations. The position of the appendix was iliac in 15%, umbilical in 15%, inguinal in 11%, and pelvic in 59%. The positions of the lower pole of the caecum and base of the appendix are lower and more medial than previously described. 70% of appendices were found to lie inferior to the interspinous line, contrary to established surgical teaching, which assumes McBurney's point to be the surface landmark for the appendix.
the caecum and terminal ileum (10-13). There has, however, been only one radiological study to determine the position of the caecum with respect to the pelvis (14). The aim of this study was, firstly, to determine the position of the lower pole of the caecum and the base of the appendix in the supine position relative to palpable bony landmarks. Secondly, to ascertain on radiological grounds why the appendix is readily accessible through a low incision for appendicectomy.
Various incisions have been described for appendicectomy (1-7). Ever since McBurney first described the point of maximal tenderness in acute appendicitis (McBurney's point) (8) and the grid-iron incision (McBurney's incision), his name has become synonymous with appendicitis. McBurney's point is the surface marking most commonly used for the base of the appendix (9). Low incisions for appendicectomy are viewed with some scepticism, mainly on the grounds that they deviate from McBurney's point. There have been several studies on the position of the normal, diseased and post-mortem appendix relative to
Correspondence to: A E Boothroyd, Department of Radiology, The Middlesex Hospital, Mortimer Street, London WlN 8AA
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McBurney's Omar M Karim
point fact or fiction? FRCS
Registrar, Academic Unit of Surgery
Anne E Boothroyd
FRCR
Senior Registrar, Department of Radiology
John H Wyllie
FRCS
Professor of Surgery
Whittington Hospital, London
Key words: Appendix; Caecum; Barium
enema
Anthropometric measurements were performed on 51 normal, supine, barium enema examinations to determine the position of the lower pole of the caecum and the base of the appendix relative to palpable bony landmarks (the anterior superior iliac spine and the symphysis pubis). Four quadrants were defined (iliac, umbilical, inguinal and pelvic) by the intersection of the right lateral line and the interspinous line (the line joining the left and right anterior superior iliac spines). The position of the lower pole of the caecum was iliac in 12%, inguinal in 37%, and pelvic in 51%. The appendix or appendix stump was visualised on 53% of the barium examinations. The position of the appendix was iliac in 15%, umbilical in 15%, inguinal in 11%, and pelvic in 59%. The positions of the lower pole of the caecum and base of the appendix are lower and more medial than previously described. 70% of appendices were found to lie inferior to the interspinous line, contrary to established surgical teaching, which assumes McBurney's point to be the surface landmark for the appendix.
the caecum and terminal ileum (10-13). There has, however, been only one radiological study to determine the position of the caecum with respect to the pelvis (14). The aim of this study was, firstly, to determine the position of the lower pole of the caecum and the base of the appendix in the supine position relative to palpable bony landmarks. Secondly, to ascertain on radiological grounds why the appendix is readily accessible through a low incision for appendicectomy.
Various incisions have been described for appendicectomy (1-7). Ever since McBurney first described the point of maximal tenderness in acute appendicitis (McBurney's point) (8) and the grid-iron incision (McBurney's incision), his name has become synonymous with appendicitis. McBurney's point is the surface marking most commonly used for the base of the appendix (9). Low incisions for appendicectomy are viewed with some scepticism, mainly on the grounds that they deviate from McBurney's point. There have been several studies on the position of the normal, diseased and post-mortem appendix relative to
Correspondence to: A E Boothroyd, Department of Radiology, The Middlesex Hospital, Mortimer Street, London WlN 8AA
Figure 1.
McBurney's point oo In _ 11 r- t- 0 - C14t-m 0 00-elN-r4
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