management
Last reviewed 01/2018
Frequently, a retrocaecal appendix is difficult to access. It is approached by a standard incision in the right iliac fossa that may need extending laterally with oblique division of the abdominal wall muscles. Once in the peritoneum, it may be necessary to mobilise the lower pole of the caecum by dividing the peritoneum along its lateral border.
The appendix is found and clamped at the distal tip of the caecum. It is divided and ligated at its base and, as with a normal appendicectomy, the stump is invaginated into the caecum and secured with a purse-string suture. The appendix remains suspended by the mesoappendix. To deliver the mesoappendix into the wound may require the caecum to be replaced. The mesoappendix is clamped, ligated and divided in close proximity to the appendix.