Slovenská chirurgia 3/2023

Subhepatic acute appendicitis – atypical presentation

Introduction: Subhepatic acute appendicitis is a very rare cause of acute abdomen. Preoperative diagnosis of subhepatic acute appendicitis is a challenge because of its rarity and atypical presentation. Imaging may be helpful for determining the correct diagnosis. Surgery is the treatment of subhepatic acute appendicitis. Case presentation: A 36-year-old male presented to the Emergency Department with history of abdominal pain, nausea, and vomiting. Physical examination revealed right upper quadrant abdominal pain without tenderness or guarding. Laboratory tests reported high levels of C-reactive protein and neutrophilic leukocytosis, USG abdomen was normal. Abdominal contrast-enhanced computer tomography showed retrocecal subhepatic phlegmonous and perforated appendicitis. The patient underwent laparoscopic appendectomy that was converted to laparotomy. The postoperative course of the patient was uneventful. Conclusion: Subhepatic acute appendicitis is a rare surgical emergency that should be considered in the differential diagnosis of patients with right upper quadrant abdominal pain. Preoperative diagnosis needs a high index of suspicion and is facilitated by imaging (CT or MRI). Surgery is the appropriate treatment of subhepatic acute appendicitis.

Keywords: appendicitis, acute appendicitis, subhepatic acute appendicitis, case presentation