Subhepatic acute appendictits in a 10-year-old male child; typical presentation with atypical location: A case report.

Acute appendicitis, the most frequent emergency in digestive surgery, is a well-known pathology in children and young adults. Its diagnosis presents some difficulties in the elderly. Appendicitis taking place in the subhepatic space (i.e., subhepatic appendicitis) is largely not common, and it occurs as a result of intestinal malrotation and/or mal-descent of the cecum during embryonic development. In our case a 10 year old male child has presented in the emergency department of Pakistan Railway Hospital, with complaints of pain at the right iliac fossa, associated with nausea and three episodes of vomiting. The child also had decreased oral intake since developing the pain. On examination, the child had a pulkse rate of 100 beats per min and a blood pressure of 100/60mmHg. The abdomen was soft with marked tenderness at the right iliac fossa along with guarding in the lower abdomen. There was associated rebound tenderness and psoas sign was also positive. After optimization open appendectomy planned, The caecum was found to be reaching the lower border of the liver and upon mobilizing the caecum, the appendix was located in a sub-he patic retrocecal position (Image 1). The appendix was markedly inflamed and was tortuous in its course with adhesions attaching it to the wall of the caecum. It has been concluded that among 0.009 percent subhepatic acute appendicitis presentation our 10-year-old child was an addition but with typical symptoms of acute appendicitis.