SUBHEPATIC APPENDICITIS: A RARE ANATOMICAL VARIANT MIMICKING ACUTE CHOLECYSTITIS danielbarocio03@gmail.com

PE091

SUBHEPATIC APPENDICITIS: A RARE ANATOMICAL VARIANT MIMICKING ACUTE CHOLECYSTITIS

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Mexico

Poster Exhibition only

Acute appendicitis is a frequent surgical emergency. Anatomical variations of the vermiform appendix may alter its clinical presentation. Subhepatic appendicitis, with an incidence of 0.08%, was first described in 1955 by King. It usually results from incomplete cecal rotation, a form of intestinal malrotation occurring in ~0.2% of births

A 53-year-old male with no significant medical history presented with sudden-onset colicky pain (VAS 10/10) in the right flank radiating to the mesogastrium, improving in the antalgic position, and unrelated to food intake. He denied nausea, vomiting, or fever. Physical examination revealed tenderness in the right flank, negative McBurney and Blumberg signs, and positive Murphy’s sign. Abdominal CT demonstrated tomographic findings consistent with acute appendicitis in a high (subhepatic) location.

Laparoscopic appendectomy was attempted but converted to open surgery due to firm adhesions to the liver and duodenum. The patient’s postoperative recovery was favorable, with discharge on the 2nd postoperative day. Subhepatic appendicitis is rare and may mimic acute cholecystitis or other upper abdominal pathologies, delaying diagnosis and management. Awareness of this anatomical variant and the use of imaging, especially CT, are essential to avoid misdiagnosis and ensure timely surgical intervention.

Although uncommon, subhepatic appendicitis should be considered in patients with right upper quadrant pain and atypical signs of appendicitis. Prompt recognition and appropriate imaging can reduce complications and improve outcomes.