Variations in Peritoneal Lines of Attachment of the Cecum, Appendix, and Terminal Ileum in Adult Females

Objective: Gynecologic surgery often necessitates mobilization of the cecum and terminal ileum for adequate operative exposure. The objective of this study was to document the individual variations in peritoneal attachments of the ileocecum in adult female patients without a history of abdominal surgeries. Study Design: This was a prospective observational study from January 1, 2013 to June 30, 2013. All patients undergoing laparotomy or minimally invasive gynecologic surgery were eligible. Patients who had undergone prior pelvic surgery (except tubal sterilization), had apparent evidence of a concurrent or prior pelvic inflammatory process, or had extensive pelvic peritoneal disease (advanced ovarian cancer, severe endometriosis) were excluded. Results: Seventy-one patients were accrued. The most common preoperative diagnosis was uterine cancer (n=34). A minimally invasive approach was employed in the majority of procedures (71.8%). Forty-five patients were noted to have natural or congenital peritoneal attachments. The frequency of peritoneal attachments by type was as follows: cecal (57.7%), terminal ileum (18.3%), and appendix (18.3%). Most of the peritoneal attachments were adhesive in nature and centralized to the right common iliac artery. During the mobilization process, the gonadal vessels and ureter were commonly encountered. Conclusion: Unrelated to prior surgery, a substantial number of women will have adhesions of the ileocecal region. (J GYNECOL SURG 31:209)