The Vermiform Process or Appendix (processus vermiformis) (Fig. 1073) is a long, narrow, worm-shaped tube, which starts from what was originally the apex of the cecum, and may pass in one of several directions: upward behind the cecum; to the left behind the ileum and mesentery; or downward into the lesser pelvis. It varies from 2 to 20 cm. in length, its average being about 8.3 cm. It is retained in position by a fold of peritoneum (mesenteriole), derived from the left leaf of the mesentery. This fold, in the majority of cases, is more or less triangular in shape, and as a rule extends along the entire length of the tube. Between its two layers and close to its free margin lies the appendicular artery (Fig. 1073). The canal of the vermiform process is small, extends throughout the whole length of the tube, and communicates with the cecum by an orifice which is placed below and behind the ileocecal opening. It is sometimes guarded by a semilunar valve formed by a fold of mucous membrane, but this is by no means constant.