A Retrocaecal Appendix Presenting With Recurrent Right Upper Quadrant Pain (RUQ): A Rare Presentation of a Rather Common Surgical Pathology

Acute appendicitis remains one of the most common causes of acute surgical abdomen. Variations in the anatomical position of the appendix can result in atypical clinical presentations with a variety of differential diagnoses and different diagnostic pathways being followed. This can ultimately lead to diagnostic delays with associated risks of increased complications. Subhepatic appendicitis is an exceptionally rare anatomical variant of acute appendicitis. We present the case of a 31-year-old female who reported symptoms of appendicitis but had a prior history of recurrent right upper quadrant (RUQ) pain in the absence of biliary pathology. Preoperative computed tomography (CT) of this lady revealed a long retrocecal appendix with its inflamed distal tip extending into the subhepatic space. CT imaging proved critical in identifying the cause of pain and the unusual anatomical position, thereby avoiding a potential missed diagnosis on ultrasound. Although rare, subhepatic appendicitis should be considered in patients presenting with right upper quadrant or atypical abdominal pains, especially when more common differentials, such as biliary disease, have been excluded. The patient underwent an uneventful laparoscopic appendectomy using a standard three-port technique without modification. We conclude that a high index of suspicion for variant positions of the appendix is required. Conventional laparoscopic port placement remains effective even in anatomical anomalies. Familiarity and experience with this approach may optimise surgical outcomes while minimising risks associated with altered techniques.