EP 640 Unusual Presentation of Acute Appendicitis: A Case Report
Roisin McKenna Favier, Zon Oo, Ciara McGloin, Ruaridh Glancy, Wadah Mohamed, Samer ZinoAbstract
Background
Acute appendicitis is a common surgical emergency typically presenting with right iliac fossa (RIF) pain. However, anatomical variations in appendix position can lead to atypical presentations, potentially delaying diagnosis and management.
Case Presentation
A 16-year-old male presented with a two-day history of RUQ pain and general malaise. Examination revealed RUQ tenderness with a positive Murphy’s sign. Laboratory investigations showed isolated elevation of alkaline phosphatase, WCC of 14.5, and a normal CRP. Meticulous history and examination suggested retrocecal appendicitis. The patient and family were consented for a diagnostic laparoscopy.
Intraoperative Findings and Management
A standard three-port laparoscopic approach was used (11 mm infraumbilical, two 5 mm ports in the left iliac fossa and suprapubic region). Purulent fluid was identified in the pelvis and right paracolic gutter; samples were taken for C&S. The appendix was identified retro-ileal and retro-caecal, with its tip sub-hepatically extending between the second part of the duodenum and the gallbladder. Initial antegrade appendicectomy was attempted; however, full right colon mobilisation and medial rotation were required to complete the procedure safely due to its unique location.
Results
The patient received 24 hours of intravenous antibiotics followed by a five-day oral course. He recovered uneventfully and was discharged on postoperative day one. Histopathology confirmed acute appendicitis.
Conclusion
Atypical appendiceal positions pose unique challenges, not only in diagnosis, as they can mimic other intra-abdominal conditions, but also in surgical techniques. Clinicians must maintain a high index of suspicion for appendicitis in cases of atypical abdominal pain, especially in adolescents.