Discussion
The size and site of appendix varies and the most common position is retrocecal followed by pelvic.(5) Although, the appendix is a constant structure, it may be completely absent or may have two appendixes.(6) Obstruction of the lumen is believed to be the major cause of acute appendicitis. This may be caused by inspissated stool (fecolith or appendicolith), lymphoid hyperplasia, vegetable matter or seeds, parasites, or neoplasm. Escherichia coli and Bacteroides fragilis are most commonly associated with appendicitis.(7, 8)
The classical clinical manifestation of acute appendicitis including the site of maximum tenderness was first described by Charles McBurney.(9) Acute appendicitis is uncommon during infancy, but the risk increases during childhood and early adult life.(10) Low dietary fiber and carbohydrate enriched diet are associated with increased risk of acute appendicitis.(11) It is controversial whether the human appendix has any functional importance, but it is suggested to have exocrine, endocrine, and neuromuscular functions.(12)
The human appendix measures 6 to 9 cm in length and is longer in males than in females. The longest appendixes reported to be 55 cm removed from a 13-year-old boy.(13) In conclusion, the appendix removed from our patient measuring 18 cm is one of the longest appendix removed.