## Appendiceal Perforation Sites **Key Point:** The antimesenteric border is the weakest point of the appendiceal wall and is the most common site of perforation in acute appendicitis. ### Anatomical Basis The appendix has a relatively poor blood supply along its antimesenteric border, making this region more prone to ischemic necrosis and subsequent perforation. The mesenteric border, by contrast, is reinforced by the appendiceal mesentery and blood vessels. ### Clinical Significance - **Perforation rate:** Occurs in 15–30% of cases if diagnosis is delayed beyond 48 hours - **Consequence:** Leads to localized or generalized peritonitis, sepsis, and increased morbidity - **Surgical finding:** Surgeons look for perforation at the antimesenteric border during appendicectomy **High-Yield:** The antimesenteric border perforation is the classic teaching point in appendicitis pathophysiology and is frequently tested in NEET PG. ### Why Other Sites Are Less Common - **Mesenteric border:** Protected by vascular supply and peritoneal fold - **Tip:** May perforate but less frequently than antimesenteric border - **Base:** Rarely perforates due to better blood supply and muscular wall 
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