Subhepatic Appendicitis: A diagnostic conundrum

Authors

  • Biji Thomas George Department of Surgery, RAK Medical and Health Sciences University, Ras Al-Khaimah, United Arab Emirates https://orcid.org/0000-0001-5029-7779
  • Youmna Ayman RAK Medical and Health Sciences University, Ras Al-Khaimah, United Arab Emirates https://orcid.org/0000-0002-8684-6968
  • Hadi Zafar RAK Medical and Health Sciences University, Ras Al-Khaimah, United Arab Emirates https://orcid.org/0000-0001-8615-8498
  • Godfred Menezes Department of Microbiology, RAK Medical and Health Sciences University, Ras Al-Khaimah, United Arab Emirates

DOI:

https://doi.org/10.17532/jhsci.2021.1265

Keywords:

Abdominal pain, adult appendicitis score, Alvarado score, Appendicitis Inflammatory Response score, appendix, scoring, Subhepatic appendicitis

Abstract

One of the most common presentations of acute abdominal pain in the emergency setting is appendicitis. Although it can occur in both genders, when it comes to females with appendicitis, reaching a definite diagnosis can be challenging as it can mimic other diseases such as ovarian cysts/torsions, pelvic inflammatory diseases, endometriosis, and urinary tract infection or physiological reasons like menstrual pain which are exclusive to females and can occur as frequently as appendicitis. Therefore, it is crucial to make an accurate diagnosis as early as possible with the right diagnostic tools to reduce morbidity and mortality in females of child-bearing age. This is a summarized case report of an adolescent female who experienced two atypical attacks of appendicitis 1 year apart. Since the patient had mainly right upper flank pain associated with nausea, vomiting, and fever with a largely non-tender abdomen, various diagnoses such as chronic cholecystitis, biliary colic, peptic ulcer, gastroenteritis, mesenteric lymphadenitis, renal colic, mittelschmerz, and torsion of ovarian cyst were considered and treated for. The patient had no relief and underwent numerous investigative procedures in the 2 years she suffered from her illness. The final diagnosis was only obtained when exploratory laparoscopy was performed. This article aims to remind clinicians to have a high index of suspicion for acute appendicitis in all atypical presentations of acute appendicitis. The latest WSES Jerusalem guidelines for the workup for patients at risk of acute appendicitis should be meticulously followed.

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Published

2021-05-28

How to Cite

George, B. T., Ayman, Y., Zafar, H., & Menezes, G. (2021). Subhepatic Appendicitis: A diagnostic conundrum. Journal of Health Sciences. https://doi.org/10.17532/jhsci.2021.1265

Issue

Section

Case reports