When appendicitis mimics a liver abscess: diagnostic challenges in pediatric surgery

Subhepatic abscesses are rare complications of acute appendicitis, often caused by delayed diagnosis and atypical presentation. We report the case of a 3-year-old male presenting with fever and abdominal pain, later diagnosed with a subhepatic abscess secondary to acute appendicitis. Abdominal imaging revealed multiple abscesses, including a primary subhepatic abscess adjacent to liver segments V and VI, and a retrocecal inflamed appendix with an appendicolith. The patient was treated with antibiotics and underwent laparotomy, drainage of the subhepatic abscess, and removal of a gangrenous appendix. Surgical exploration revealed inflammatory adhesions involving the duodenum and adjacent intestinal structures, which were meticulously dissected and managed. This case underscores the importance of high clinical suspicion and timely imaging in pediatric patients with atypical presentations of acute appendicitis.