Presentation
Right flank pain, trace blood in urine ?renal colic.
Patient Data
The appendix tip lies in a subhepatic position and is dilated with mild surrounding fat stranding.
No free fluid or free gas. Colon and small bowel are unremarkable. Fatty liver. Normal appearing kidneys, spleen, adrenal glands and pancreas. No urolithiasis identified.
The patient proceeded to appendectomy.
Histopathology report
MACROSCOPIC DESCRIPTION: "Appendix": An appendix 96mm in length by up to 9mm in diameter with minimal mesoappendix at the tip up to 20mm in maximum width. The serosa is pale and transluscent. There is no evidence of exudate. Base margin en-face inked green, tip and five transverse sections.
MICROSCOPIC DESCRIPTION: The sections show appendix which has a focally ulcerated mucosal surface and acute inflammation extending through the appendiceal wall. There is no evidence of malignancy.
DIAGNOSIS: Acute appendicitis.
Case Discussion
Subhepatic appendix is a rare location (<0.1%), and when inflamed can present mimicking both renal colic (as in this case) or biliary colic.
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