Subhepatic appendicitis

Case contributed by Dr Islam Mohamed El Gezeiry

Presentation

Patient presented with periumbilical pain that migrated to the right hypochondrium laterally at the same day of presentation.

Patient Data

Age: 25 yrs
Gender: Male
Ultrasound

The subhepatic region revealing a non-compressible blind-ended distended aperistaltic tubular structure, showing positive probe tenderness sign on compression and a fecolith noted at its medial end. Minimal amount of fluid collection was noted around its tip and in the lateral subhepatic region. 

Case Discussion

Findings supportive of the diagnosis of appendicitis include 4:

  • aperistaltic, noncompressible, dilated appendix (>6 mm outer diameter)
  • appendicolith
  • distinct appendiceal wall layers
  • echogenic prominent pericaecal fat
  • periappendiceal fluid collection
  • target appearance (axial section)

Confirming that the structure visualised is the appendix is clearly essential and requires demonstration of it being blind ending and arising from the base of the caecum.

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Case information

rID: 43733
Case created: 23rd Mar 2016
Last edited: 3rd Oct 2016
Inclusion in quiz mode: Included

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