Sessile ileum, subhepatic cecum, and uncinate appendix that might lead to a diagnostic dilemma

Abstract

The subhepatic position of the cecum and appendix is a result of embryological reasons. Subhepatic appendicitis can cause diagnostic dilemmas. During the dissection of an adult male cadaver aged approximately 70 years, the subhepatic position of the cecum and appendix was noted. The appendix made a "U"-shaped bend and its tip was located in the paracolic position. The cecum had appendices epiploicae, and the terminal part of the ileum was retroperitoneal and had ascended vertically to the cecum from the right iliac fossa. Functionally, the sessile part of the ileum might restrict its peristaltic movements. The abnormal position of the terminal ileum might be mistaken for an ascending colon during laparoscopic surgery. The subhepatic position of the cecum and appendix might cause confusion in the diagnosis of acute appendicitis because the tenderness in such cases is not located at the McBurney's point.

Sub-hepatic Caecum with Extra-pelvic Looped Sigmoid Colon: An Embryological and Clinical Perspective

“…The cases of gut malrotation have been reported sporadically. [3][4][5][6][8][9][10] The cases with sub-hepatic caecum are often asymptomatic throughout life hence remain undiagnosed. This condition becomes clinically significant during appendicitis referred to as sub-hepatic appendicitis, as these cases present with atypical symptom of pain radiating from umbilical region to right hypochondria.…”

“…8 Prompt diagnosis of subhepatic caecum with appendix is essential as in these cases infection from appendix may rapidly invade right kidney and suprarenal gland. 9 Hence early diagnosis and treatment is crucial to prevent life threatening complications. On exploring the previous reports, we found only few reports highlighting dilated-looped sigmoid colon outside pelvic cavity referred as 'Dolichocolon'.…”

Subhepatic appendicitis masquerading as acute cholecystitis: a lesson learnt!

“…Subhepatic appendicitis can mimic other acute surgical abdominal conditions and can lead to a diagnostic dilemma. As surgery is the treatment of choice for appendicitis, establishing a proper diagnosis is of paramount importance especially to avoid dreadful complications like appendicular abscess, rupture and faecal peritonitis . This case illustrates the difficulty encountered in trying to diagnose acute appendicitis in patients whose appendix is mal‐located during foetal development.…”

“…As surgery is the treatment of choice for appendicitis, establishing a proper diagnosis is of paramount importance especially to avoid dreadful complications like appendicular abscess, rupture and faecal peritonitis. 1,2 This case illustrates the difficulty encountered in trying to diagnose acute appendicitis in patients whose appendix is mal-located during foetal development. We present this case of obstructive appendicitis, where in the diagnosis was established by radiological investigations and managed successfully.…”

“…Acute appendicitis is one of the most common, easily diagnosed surgical emergencies and accounts for 1% of all surgical operations. Various appendicular positions that is retrocaecal (65.28%), pelvic (31%), subcaecal (2.26%), preileal (1%) and postileal (0.4%) have been described, but subhepatic position is a very rare position and is the result of a developmental anomaly (maldescent), where‐in caecal descent towards the right iliac fossa is arrested and it lies in the subhepatic area . Palanivelu et al .…”