Malrotated Subhepatic Caecum with Subhepatic Appendicitis: Diagnosis and Management.

Hock Chin Chong,Feng Yih Chai,Siti Mohd Desa Asilah,Irene Nur Ibrahim Adila,Dhayal Balakrishnan,Khuzaimah Zahid Syibrah

doi:10.1155/2016/6067374

Hock Chin Chong, Feng Yih Chai + Show 4 more

Open Access

https://doi.org/10.1155/2016/6067374

Copy DOI

Abstract

Subhepatically located caecum and appendix is a very rare entity. It occurs due to the anomaly in fetal gut rotation that results in an incomplete rotation and fixation of the intestine. Appendicitis, which is a common surgical emergency, in combination with the abnormal subhepatic location, presents a great challenge in its diagnosis and management. Here, we describe a 42-year-old male with chronic dyspepsia who presented with sepsis and severe pain at his right hypochondriac and epigastric region. The final diagnosis was acute appendicitis of the subhepatic appendix. Our discussion focuses on the diagnostic approach and clinical and surgical management. We hope that our report will increase the awareness among the clinicians and hasten the management of such rare condition to avoid complications.

Highlights

Acute appendicitis, which is a common surgical emergency, in combination with the rare subhepatic location, presents a significant challenge in its diagnosis and management
We describe a 42-year-old male with chronic dyspepsia who presented with sepsis and severe right hypochondriac and epigastric regions’ pain
We performed the laparoscopy via a supraumbilical 10 mm optic port and two 5 mm working ports at both iliac fossae. We found that his ascending colon was short and that the caecum was located just below the liver at the right hypochondriac region

Summary

Introduction

Acute appendicitis, which is a common surgical emergency, in combination with the rare subhepatic location, presents a significant challenge in its diagnosis and management. It can mimic cholecystitis and liver abscess, may lead to delayed diagnosis, and increases the chances of appendiceal rupture [1, 2]. We describe a 42-year-old male with chronic dyspepsia who presented with sepsis and severe right hypochondriac and epigastric regions’ pain. Our discussion focuses on the diagnostic approach and clinical and surgical management. We hope that our report will increase the awareness among clinicians of such a rare condition and hasten its management to avoid complications

Case Presentation

Discussion

Findings

Conclusion