Peculiarities of diagnosis and management for subhepatic appendicitis

Acute appendicitis is a frequent abdominal emergency and has a well-codified management. Its symptoms depend on the caeco-appendicular anatomy and the stage of the disease. In a subhepatic position, appendicitis poses a diagnostic and therapeutic problem. We report three paediatric patients, a 9-year-old boy and two 15-year-old girls, admitted with atypical acute abdominal pain. Ultrasound showed appendicitis in the two girls, but failed to conclude on the subhepatic position of appendicitis. In the boy, his computed tomography (CT) of the abdomen showed a subhepatic mass. The final diagnosis was acute subhepatic appendicitis for all the patients. All the patients were managed by open surgery. The first patient was initially managed via laparoscopic surgery but difficulties visualizing the appendix due to adhesions motivated a conversion. The postoperative course was uneventful for two patients and complicated by retroperitoneal abscess for one patient who was hospitalised for 10 days. Subhepatic location of appendicitis causes diagnostic delay and additional morbidity. The young age of the patient, the delay of the diagnostic and therapeutic resources available may contribute to greater difficulty managing this condition.