*Endothelial Dysfunction in Appendicitis DOI: http://dx.doi.org/10.5772/intechopen.107480*

**Figure 1.** *The anatomy of vermiform appendix and the cecum (left) and its anatomical variations (right) [6].*

appendicular artery was 1 single branch from the ileocolic artery vascularize the whole appendix which then performed networks of smaller arteries perforating into the layers of appendix. The vascularization of the appendix originates from mesenteric blood circulation which is also responsible for other parts of the intestinal circulation. The appendicular artery is one of the most distal parts of the branches from the superior mesenteric circulation. Although it is part of the huge mesenteric circulation, as appendiceal circulation took a little part and branch among the circulation, the regulation of blood flow is less and lower than in other parts of the mesenteric circulation such as in the ileum or ascending colon. However, regulation of the blood flow is commonly maintained by local factors with vasodilator effects induced and attributed by hypoxia or cytokines of inflammation to cause an increase in blood flow to the appendix. Certain osmotic mechanisms, autonomic and neurohumoral, also the intestinal wall activity of peristalsis affect the blood flow in the mesenteric circulation primarily the special circulation to the appendix [6, 8].

Metabolic end products from the tissue in the vermiform appendix were drained away by the venous drainage which anatomically will join the venous blood flow in the ileocolic vein and the superior mesenteric vein. Another non-venous drainage of the appendix occurs by the lymphatic drainage of the cecum and the appendix which passes the lymph nodes in the mesoappendix and ileocolic lymph nodes surrounding the ileocolic artery into a group of superior mesenteric lymph nodes (**Figure 2**) [9].

The vermiform appendix is known as a vestigial organ embryologically and by the evolution of mammals. The main functions of vermiform appendicitis itself remain unknown. Theories stated that in humans the vermiform appendix no longer functions but other theories counters. As histologically it is rich in lymphoid tissue and its vascularization and lymphatics, its function is mostly discussed related to the immunological functions, especially to the gastrointestinal system. As its luminal and noncontinuous structure, the vermiform appendix was also hypothesized to be a reservoir for gut microbiota. This function and structure were suspected to have strong correlations to inflammatory mediators and microbiological mechanisms of the bacteria.

**Figure 2.** *Arterial supply of the vermiform appendix [6].*

This puts the vermiform appendix as an organ with a lot of risks of inflammations and infections its homeostasis was disrupted [10].
