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Subhepatic Appendicitis With Appendicular Diverticulitis: A Rare Combination for Acute Abdomen
Midhun Mathew1, Sandra Hembrecht2, Kasi Visalatchi Subramanian1
1Department of Surgery, Beaumont Hospital, Dublin, IRL.
Cureus
|October 7, 2024
Summary
This case report details a rare simultaneous occurrence of subhepatic appendicitis and appendiceal diverticulitis. Management involved converting from laparoscopy to laparotomy for safe appendix resection.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Abdominal Imaging
Background:
- Subhepatic appendicitis and appendiceal diverticulitis are uncommon conditions that can mimic acute appendicitis.
- Simultaneous presentation of both is exceedingly rare, posing diagnostic and surgical challenges.
Observation:
- A 41-year-old male presented with right iliac fossa pain, nausea, and fever.
- CT revealed acute appendicitis with a subhepatic appendix; emergent laparoscopic appendicectomy was planned.
- Intraoperative findings included adhesions to the duodenum, right kidney, and transverse colon, necessitating conversion to laparotomy.
Findings:
- Histopathology confirmed appendiceal diverticulitis with a subserosal abscess.
- The subhepatic position of the cecum and appendix was attributed to fetal gut malrotation.
Implications:
- This case highlights the importance of considering rare pathologies in atypical presentations of appendicitis.
- Laparotomy conversion provided improved access and tactile feedback for managing complex adhesions.
- Educating on managing such unusual presentations is crucial for surgical outcomes.
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