Teferi Dagmawi Anteneh, Gebru Shanko, Kassa Alexander Tewodros, Abebe Helina Amare, Yehualawork Solomon Fekadu, Teferi Wubhareg Anteneh
Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Int J Surg Case Rep. 2024 Dec;125:110540. doi: 10.1016/j.ijscr.2024.110540. Epub 2024 Oct 29.
Appendicitis in patients with a sub-hepatic and retroperitoneal position is rare, often leading to delayed diagnosis and management due to its atypical presentation. A high index of clinical suspicion and the use of imaging modalities can improve the outcomes of patients with sub-hepatic appendicitis.
A 20-year-old male presented with 36 h duration of right-sided abdominal pain, accompanied by nausea, vomiting, anorexia, and fever. He exhibited tachycardia and right lower quadrant abdominal tenderness. Laboratory tests revealed leukocytosis with a left shift and ultrasound showed simple appendicitis. An open appendectomy revealed a retroperitoneal, sub-hepatic, and sub-serosal inflamed appendix. The patient's postoperative course was uneventful.
Sub-hepatic position of the appendix is rare accounting for 0.08 % of all cases of acute appendicitis. It is associated with mid-gut mal-rotation or arrested cecal descent during embryogenesis. Patients with sub-hepatic appendicitis usually have atypical presentation mimicking hepatobiliary pathologies which will lead to a delayed diagnosis and management. The standard management of sub-hepatic, retroperitoneal, and sub-serosal appendicitis relies on a laparoscopic approach however in case of difficulty and resource limitation, open appendectomy is the ultimate option.
Sub-hepatic retroperitoneal and sub-serosal appendicitis, though rare, should be included in the differential diagnosis for patients with atypical abdominal pain. A high index of clinical suspicion, use of imaging modalities, and meticulous dissection with adequate exposure are crucial for a successful outcome.
肝下及腹膜后位阑尾炎较为罕见，因其表现不典型，常导致诊断和治疗延迟。高度的临床怀疑指数及影像学检查手段的应用可改善肝下阑尾炎患者的治疗效果。
一名20岁男性，右侧腹痛36小时，伴有恶心、呕吐、厌食及发热。他出现心动过速及右下腹压痛。实验室检查显示白细胞增多并伴有核左移，超声显示为单纯性阑尾炎。开放阑尾切除术中发现阑尾位于腹膜后、肝下及浆膜下且有炎症。患者术后恢复顺利。
阑尾肝下位罕见，占所有急性阑尾炎病例的0.08%。它与胚胎发育过程中中肠旋转不良或盲肠下降停滞有关。肝下阑尾炎患者通常有类似肝胆疾病的非典型表现，这会导致诊断和治疗延迟。肝下、腹膜后及浆膜下阑尾炎的标准治疗方法是腹腔镜手术，但在困难及资源有限的情况下，开放阑尾切除术是最终选择。
肝下腹膜后及浆膜下阑尾炎虽罕见，但对于有非典型腹痛的患者应列入鉴别诊断。高度的临床怀疑指数、影像学检查手段的应用以及充分暴露下的细致解剖对于取得成功的治疗效果至关重要。
