Undescended Ampullary Caecum in the Right Lumbar Region: Case Report of a Rare Cadaveric Presentation

Abstract

The caecum is usually found in the right iliac fossa (RIF) and is clinically important for identifying acute abdominal conditions like appendicitis. Caecum positional variants are rare congenital malformations caused by incomplete midgut rotation and fixation. They are usually accompanied by unusual clinical signs and symptoms that can make the diagnosis difficult. During routine dissection for undergraduate medical students at Bharati Vidyapeeth DU Medical College, Pune, undescended caecum was observed superiorly in the right lumbar region in an adult female cadaver. It was ampullary in shape, with a significantly shortened ascending colon; the vermiform appendix attached at 2 o'clock position on the posteromedial surface.

This is a high position, indicating a third-stage stop of midgut rotation, with partial descent and peritoneal fixation of the caecum. This lumbar topography affects the basic pattern of pain referral. Which can lead to the misinterpretation of acute appendicitis as renal colic or pyelonephritis. Also, loss of mesocolic fixation significantly increases the risk of caecal volvulus. We present a rare case of a lumbar caecum, including its development and clinical importance. Knowledge of these high-lying caecal anomalies is critical for the surgeon, radiologist, and anatomist in order to make an accurate diagnosis, anticipate accompanying vascular variations, and reduce iatrogenic hazards during surgery.