Subhepatic retained appendiceal tip harbouring adenocarcinoma: a surgeon's dilemma

Subhepatic appendicitis is a rare anatomical variant that mimics hepatobiliary pathology, leading to diagnostic delay and technical difficulty at surgery. We describe a 69-year-old man who underwent emergency laparoscopic appendicectomy for sepsis, complicated by dense subhepatic adhesions resulting in incomplete resection and a retained appendiceal tip. Histopathological examination unexpectedly demonstrated moderately differentiated appendiceal adenocarcinoma with isolated loss of postmeiotic segregation increased 2 expression. Three weeks later, the patient re-presented with recurrent sepsis due to pyogenic liver abscesses and a hepatic lesion suspicious for metastatic disease. Multidisciplinary assessment led to radical right hemicolectomy, cholecystectomy, and limited liver resection. Final histopathology confirmed locally advanced disease with direct T4 invasion into the liver and clear (R0) margins. This case highlights the need to consider subhepatic appendicitis in unexplained right upper quadrant sepsis and emphasizes the importance of early multidisciplinary management when retained appendiceal tissue is suspected, as radical resection may be curative.