Subhepatic appendicitis: a diagnostic dilemma

Abstract

A middle-aged woman was admitted with recurrent episodes of ill-defined right-sided abdominal pain, more prominent in the right upper quadrant. Surgical history revealed a laparoscopic cholecystectomy, 1 month prior, for gallstones that were thought to be the cause of her symptoms. However, she continued to experience similar pain with exacerbation leading to readmission. Blood tests revealed increased inflammatory markers and an ultrasound scan showed a tubular hypoechoic structure between her right kidney and liver corresponding to the area of maximal tenderness. A diagnostic laparoscopy was performed and a subhepatic inflammatory mass of appendicular origin was found. This required mobilisation of the right colon and appendicectomy. The patient made an uneventful recovery after being readmitted for an ileus treated conservatively. Histology revealed acute appendicitis with mucosal ulceration.

Variations in the Position and Length of the Vermiform Appendix in a Black Kenyan Population

“…A notable observation in the present study was the relatively high frequency of subhepatic appendix (4.2%), only comparable to 4% reported among Pakistani's [ 15 ]. This position is thought to be caused by defective migration of the caecum during development or due to adhesions [ 7 , 29 , 30 ]. Knowledge of this position is important because subhepatic appendicitis can cause a diagnostic dilemma as it may mimic hepatobiliary or renal disease [ 7 , 29 , 30 ].…”

Subhepatic appendicitis masquerading as acute cholecystitis: a lesson learnt!

“…4 Appendicular abscess is the most reported complication in this site and rupture is a rare event, which could happen because of a delay in diagnosis. 7 Obstructive appendicitis can be due to a faecolith as in our patient or parasitic infestation, Ascaris lumbricoides being the commonest. 8 LA can be easily performed in these patients, resulting in shorter hospital stay and less post-operative complications.…”

“…In situations where abdominal CT is inconclusive, clinical diagnosis of appendicitis remains doubtful and the patient remains clinically unwell, a diagnostic laparoscopy is recommended . Appendicular abscess is the most reported complication in this site and rupture is a rare event, which could happen because of a delay in diagnosis . Obstructive appendicitis can be due to a faecolith as in our patient or parasitic infestation, Ascaris lumbricoides being the commonest …”

Subhepatic Appendicitis in an 11-year-old Boy: A Case Report

“…When the appendix is located in an atypical position, patients may present with unusual clinical symptoms. This can result in a delay in the diagnosis and unfavorable complications such as perforation and abscess formation [1,6].…”