Surgical management of subhepatic perforated appendicitis: a case report
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(2020) 14:151
CASE REPORT
Open Access
Surgical management of subhepatic perforated appendicitis: a case report Mumin Hakim, Rania Mostafa, Mohammed Al Shehri and Sherif Sharawy*
Abstract Background: Subhepatic appendicitis is an exceedingly rare presentation, accounting for 0.01% of acute appendicitis cases. It is of prime importance to be aware of variants and manage such challenging cases accordingly. Case presentation: We present a case of a middle-aged Saudi woman with subhepatic perforated appendicitis and peritonitis who underwent an exploratory laparotomy and appendectomy. Conclusions: The initial diagnosis and surgical management of such patients is challenging due to an atypical presentation. The surgical management of such patients is discussed with a brief review of the literature. Keywords: Subhepatic appendicitis, Peritonitis, Laparotomy, Case report
Background The appendix, a vestigial organ, is a small, tubelike structure that belongs to the midgut of the digestive tract system. The most common location of the appendix is retrocecal (74%), followed by the pelvic (21%) region. Other locations include subcecal (1.5%), preileal (1%), and postileal (0.5%) positions [1]. Acute appendicitis continues to be one of the most frequently encountered surgical emergencies in children and adults. The site of a normally placed appendix and its classical presentation of appendicitis are well documented in the literature. However, the deviations in the anatomical position of the appendix contribute to the difficulty in diagnosing appendicitis [2–8]. Subhepatic, left-sided, intraherniary, lateral pouch, mesocolic, and lumbar positions are rare positions of the appendix. It is of prime importance to be aware of variants and manage such challenging cases accordingly. Subhepatic appendicitis
* Correspondence: [email protected] Department of General Surgery, Saudi German Hospital, Al-Aseer, Kingdom of Saudi Arabia
could mimic cholecystitis and liver abscess, resulting in delayed diagnosis and appendiceal rupture [1, 7]. We present a unique and challenging case of a middle-aged woman with subhepatic perforated appendicitis and peritonitis. The case is unique in its diagnosis and management, which are challenging. This case report will make readers aware of a rare presentation and its management. The surgical management of such patients is discussed along with a brief review of the literature.
Case presentation Our patient was a 41-year-old Saudi woman, a homemaker with no employment history and no known past medical history. She was not taking any home medications. She had no relevant or pertinent social, environmental, or family history and no prior smoking habit or alcohol consumption. She had a history of two normal vaginal deliveries followed by a cesarean section 1 year earlier, in August 2019. She presented to our hospital with abdominal pain of 3 days’ duration. The pain had started in the epigastric region, progressed in intensity over the 3
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