Open appendectomy for subhepatic appendicitis in an adult male: A case report

Subhepatic appendicitis is an uncommon anatomical variant of acute appendicitis, with a documented incidence of approximately 0.08 %. It poses notable diagnostic challenges due to its atypical symptomatology. In resource-constrained setting, delayed diagnosis is common due to limited access to advanced imaging techniques, thereby requiring a clinical judgement.

We describe the case of a 33-year-old male presenting with acute abdominal pain that initially originated in the periumbilical region and subsequently localized to the right upper quadrant, accompanied by episodes of vomiting. Initial ultrasonographic (USG) evaluation was inconclusive; however, a focused repeat USG revealed a non-compressible, inflamed tubular structure in the subhepatic region. Based on clinical findings, a diagnosis of subhepatic appendicitis was established. The patient underwent emergency open appendectomy via a gridiron incision. Intraoperative findings confirmed an inflamed appendix located in the subhepatic space.

Due to its unusual anatomical position and non-specific clinical features, subhepatic appendicitis is frequently misdiagnosed. Diagnostic imaging, particularly USG and computed tomography (CT), plays an essential role; however, CT availability may be limited in under-resourced settings. In such cases, diagnostic can be made through the use of clinical scoring systems, high degree of suspicion in combination with targeted USG. Open appendectomy is a dependable surgical approach, especially when laparoscopic facilities are unavailable.

Subhepatic appendicitis should be considered in the differential diagnosis of right upper quadrant abdominal pain suggestive of appendicitis, especially when the appendix is not visualized using standard imaging techniques. Prompt clinical judgement and timely surgical intervention are vital to minimizing complications and ensuring favorable patient outcomes.