Subhepatic Appendicitis Presenting With Recurrent Abdominal Pain

Abstract

Gut malrotation may result in failure of descent of the cecum to the right iliac fossa, resulting in the anomaly where the cecum and appendix are situated in the subhepatic/gallbladder region. Although the true incidence of subhepatic cecum or appendix is not known, there is a handful of case reports in the literature describing the diagnosis and management of subhepatic appendicitis and associated challenges. Some case reports describe subhepatic appendicitis, where the cecum is in a normal position, but the subhepatic tip of the long appendix gets perforated or inflamed, resulting in the process being in the subhepatic region. We report a patient with subhepatic appendicitis, who had multiple episodes of abdominal pain for almost one year, treated with antibiotics, but was never diagnosed properly. The case was diagnosed by abdominal sonography and was managed successfully in our institution.

Keywords: acute appendicitis; cecum; gut malrotation; laparotomy; subhepatic.

Figure 1. Intraoperative image showing inflamed subhepatic appendix (Green arrow), liver (Yellow arrow), gall bladder (Blue arrow), cecum (Black arrow), and ileum (White arrow).