Presentation
Ill-defined right-sided abdominal pain associated with vomiting.
Patient Data
A thickened appendiceal wall (>3mm) as well as a dilated appendix (>6mm), with peri-appendiceal fat standings along with a related rim of fluid, suggests appendicitis.
Dilated tubular structure with enhancing wall seen at the right side of the abdomen that extends from the right iliac region up to the subhepatic region with related inflammatory fat stranding with a related rim of fluid that keeping with acute appendicitis with suspected perforation.
Urgent pelvic U/S revealed just mild turbid pelvic collection with no definite right iliac region mass or signs of appendicitis.
Case Discussion
Our case underwent a diagnostic laparoscopy which confirms the location and revealed related turbid collection and proves its tip perforation.
Inflammation of the appendix, in an uncommon location, can lead to atypical presentations. Although ultrasound is the first-line imaging tool; subhepatic appendiceal pathologies can be easily misdiagnosed or even undiagnosed with ultrasound examination as in our case.
CT plays a vital role in identifying subhepatic appendicitis with higher accuracy.