Complicated Subhepatic Acute Appendicitis with Extensive Abscess Involving the Liver and Gallbladder in a Young Adult: Diagnostic and Surgical Challenges, Case Report and Literature Review

Literature Review

Abstract

Subhepatic acute appendicitis is a rare anatomical variant associated with atypical clinical presentations and frequent diagnostic delays, often leading to complicated forms. We report the case of a 23-year-old patient with no significant past medical history, admitted with right flank and right hypochondrial pain evolving over 12 days in a febrile context. Laboratory investigations revealed a marked inflammatory syndrome. Abdominal computed tomography demonstrated perforated subhepatic appendicitis complicated by a localized abscess. Surgical management proved challenging, requiring conversion from laparoscopy to laparotomy, with retrograde appendectomy, drainage, and concomitant cholecystectomy. Postoperative recovery was uneventful. This case highlights the diagnostic pitfalls and technical surgical difficulties associated with subhepatic appendicitis, particularly in complicated forms, and underscores the importance of individualized intraoperative decision-making.