An unusual case report of a subhepatic appendix and an interlobar hepatic bridge in a patient with acute cholecystitis.

A subhepatic appendix and an interlobar hepatic bridge are both rare anatomical variants. To find both entities in the same patient at the time of a laparoscopic cholecystectomy makes for a unique case report. Subhepatic appendicitis has a reported incidence of 0.08%, and there have been only published three case reports of an interlobar hepatic bridge. Their lack of involvement in acute cholecystitis facilitated an easier dissection process and prevented serious complications to the liver or the right hemi-colon.

Thermal Injury to the Subhepatic Appendix Following Percutaneous Ultrasound-Guided Radiofrequency Ablation for Hepatocellular Carcinoma: A Case Report.

We present the first documented case of a fistula between the treated zone and the appendix after RFA in a patient with HCC. Contrast-enhanced CT and MRI revealed a subcapsular hepatic nodule with image findings of HCC located adjacent to the ascending colon and cecum. An ultrasound-guided core needle biopsy was subsequently performed to distinguish between hepatic metastasis and HCC. Post-RFA imaging identified a low-attenuating ablated area adjacent to an air-filled appendix. The patient later experienced complications, including increased liver enzymes and an abscess at the ablation site. Imaging revealed a fistulous tract between the RFA zone and the appendix. Over the following months, the patient underwent conservative treatment involving intravenous antibiotics and repeated percutaneous drainage, exhibiting eventual symptom relief and an absence of the fistulous tract upon subsequent imaging. This case highlights the rare complications that can arise during RFA due to peculiar anatomical variations, such as a subhepatic appendix, resulting from midgut malrotation and previous surgery. It is imperative for operators to be cognizant of potential anatomical variations when considering RFA treatment, ensuring comprehensive pre-procedural imaging and post-procedure monitoring. This case also emphasizes the potential viability of nonoperative management in complex scenarios in which surgical interventions pose significant risks.

Hidden appendix: A case report and literature review of perforated acute appendicitis masquerading as acute cholecystitis.

INTRODUCTION: Acute appendicitis of the subhepatic appendix is uncommon, and a preoperative diagnosis is difficult without a thorough understanding of the various anatomical locations. Cross-sectional imaging is indispensable for prompt diagnosis and subsequent treatment. Surgery is the standard treatment for perforated appendicitis in the subhepatic region. In this study, we present a case of subhepatic appendicitis with an unusual presentation. CASE PRESENTATION: A 28-year-old man presented to our emergency department with a 3-day history of diffuse right abdominal discomfort, diarrhea, fever, and vomiting. Physical examination revealed rebound soreness and guarding in the right upper and lower quadrants. Laboratory tests revealed high levels of C-reactive protein and serum bilirubin and neutrophilic leukocytosis. Abdominal computed tomography revealed an undescended cecum and a subhepatic appendix with an intraluminal appendicolith, fat stranding, and peri-appendiceal fluid. The patient underwent open exploration and appendicectomy, during which the subhepatic perforated appendix was excised. The patient's recovery was uneventful. DISCUSSION: Atypical presentations may indicate an unusual anatomical placement of the appendix. Preoperative diagnosis using cross-sectional computed tomography imaging and a thorough understanding of these situations frequently result in early diagnosis and expeditious surgical care. CONCLUSION: Surgical crises resulting from aberrant anatomical variations of the appendix constitute a distinct diagnostic challenge. A strong index of suspicion for this uncommon presentation permits early surgical intervention and prevents delay-induced morbidity/mortality.

Subhepatic appendix: an ectopic topography not to be disregarded: a case report.

INTRODUCTION: Subhepatic appendix is most often due to an anomaly of rotation of the primary intestine occurring during embryogenesis. This ectopic topography associated with advanced age can be a serious diagnosis problem at the stage of appendicitis or appendicular peritonitis. CASE PRESENTATION: We report the case of a 60-year-old melanoderm man, with a history of urinary pathology and peptic ulcer, referred from a health district for abdominal pain of the right hypochondrium evolving for about 5 days, secondarily generalized, in whom we suspected peritonitis, the etiology of which remains to be determined. During the surgical intervention, after preoperative resuscitations measures, a phlegmonous perforated appendix was found under the liver. No postoperative complication was noted, and he was discharged home 8 days after his operation. CONCLUSION: Subhepatic appendicular peritonitis occurring in an elderly patient poses enormous diagnostic problems. When faced with right upper quadrant pain, considering acute ectopic appendicitis would significantly reduce complications.

Unusual Pneumonia Mimic.

Disease in atypical organ locations can mimic other pathologies, hampering the right diagnosis. Such conditions may even be emergencies, like appendicitis. Subhepatic appendix is a very rare entity which may be caused by caecum dehiscence failure. The authors present the case of a 55-year-old immunocompetent man admitted to the Emergency Department with sepsis and severe hypoxaemia. Chest x-ray showed right lower lobe infiltrate, and community-acquired pneumonia was diagnosed. The patient was started on broad-spectrum antibiotics, but he continued to deteriorate and after 3 days developed abdominal complaints. Exploratory laparoscopy revealed an abscess caused by perforated subhepatic appendicitis. Subhepatic appendicitis presents a diagnostic challenge and its clinical presentation may mimic that of other entities. This case highlights an atypical presentation, where the early development of inflammatory lung injury mimicked common pneumonia. Maintenance of a high index of suspicion and knowledge of these atypical locations is crucial. LEARNING POINTS: Control of the source of infection in sepsis is vital for survival.Acute inflammatory lung injury is common in sepsis and is correlated with clinical severity.A high index of suspicion and awareness of anatomical variants of the appendix are necessary for correct diagnosis of appendicitis mimicking other conditions.

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

Appendicitis is a common surgical emergency. When present in an abnormal subhepatic location, it can pose a challenge in its diagnosis and management. Subhepatic appendicitis is a rare phenomenon, especially in the pediatric age group. Herein, we present a rare case of subhepatic appendicitis in an 11-year-old boy with delayed presentation but managed successfully.

Classical Presentation of Acute Appendicitis in the Case of a Subhepatic Appendix.

Acute appendicitis is a very common surgical emergency diagnosed by combining the history, examination, and investigations to build a clinical picture. This presentation can become more complex with abnormal anatomical variations of the appendix. This case describes the rare clinical finding of a subhepatically located appendix and caecum in a 24-year-old female presenting with right lower quadrant (RLQ) pain. Examination findings were consistent with acute appendicitis. Ultrasonography identified the appendix as being located in the subhepatic region with laparoscopy confirming this finding and the presence of a malrotated caecal pole due to congenital adhesions. Laparoscopic appendectomy was subsequently performed therapeutically with no complications. This case focuses on the typical presentation of appendicitis and RLQ pain in a patient with an atypical anatomical structure. It aims to depict the importance of a widened knowledge of the aberrantly located appendix and how this can impact clinical presentation.