Abstract
Subhepatic appendicitis is rare in children and often presents with atypical symptoms and signs, resulting in delayed diagnosis with attendant complications. The presence of hyperbilirubinemia could be a marker of complicated appendicitis and may assist rural physicians to seek specialist assistance early.
Highlights
Inflammation of the appendix located in an unusual position can be challenging to diagnose due to atypical clinical presentations
A rebound tenderness would suggest localised peritonitis, but this sign may be absent when the appendix is in an unusual position, such as subhepatic location
The differential diagnoses considered in this case were acute appendicitis, cholecystitis, hepatitis, hepatic abscess, pancreatitis and pyelonephritis
Summary
Inflammation of the appendix located in an unusual position can be challenging to diagnose due to atypical clinical presentations. The appendix was retrocaecal and subhepatic, which is rare and associated with non-specific clinical signs that may mimic upper abdominal pathology[1]. Ultrasound avoids radiation risk and is a valuable investigation in suspected appendicitis, but difficulties are encountered in an abnormally positioned appendix (retrocaecal or subhepatic), bowel gas obscuring intrabdominal structures and severe tenderness limiting successful completion of the study.
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