Abstract
Appendicitis is the most common surgical emergency in children, of which most are
located in the retrocecal space or pelvis. Appendicitis occurring in the subhepatic
space is uncommon and may present with atypical features such as right upper quadrant
pain, leading to delayed diagnosis and complications. We present a rare case of subhepatic
appendicitis in an 11-year-old female, who presented with a three-day history of both
right upper quadrant (RUQ) and right lower quadrant (RLQ) abdominal pain and serum
lipase elevated four times the upper normal limit. The abdominal ultrasound was normal,
except for prominent RLQ abdominal lymph nodes. Hours later, a computed tomography
scan revealed a non-ruptured subhepatic appendicitis and normal pancreas. Our patient
encounter demonstrates the need to be aware of the atypical presentations of pediatric
appendicitis in general and subhepatic appendicitis in particular. Moreover, to our
knowledge, this is the first reported case of elevated lipase (with a radiographically
normal pancreas) in association with subhepatic appendicitis. Providers should be
aware elevated serum lipase levels may be due to conditions other than pancreatitis
and further evaluation should be considered if the elements of the clinical picture
are incongruent.
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Article Info
Publication History
Published online: October 22, 2018
Accepted:
September 25,
2018
Received:
September 5,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
