IJCRR - Vol 08 Issue 06, March, 2016
CHALLENGES IN THE MANAGEMENT OF SUBHEPATIC ACUTE APPENDICITIS IN THE EMERGENCY SETTING
Author: Bader Hamza Shirah, Hamza Assad Shirah, Wael Awad Alhaidari, Omer Elhag Abdulbagi
Introduction: Subhepatic acute appendicitis is a very rare variety of appendicitis that has rarely been reported and is difficult to diagnose. In our study, we aim to evaluate the clinical, diagnostic, and surgical approach done to 43 patients in the emergency setting to overcome the challenge. Patients and Methods: A retrospective cohort database analysis of 43 patients who were proven to have had subhepatic appendicitiswas done. 32 were male, and 11 were female (age range, 14–23). All patients presented with an acute onset of the disease to the emergency department after regular working hours.Preoperative workup was the same to all patients (blood count, chemistry, chest and abdominal X-ray and ultrasound). All patients had emergency open appendectomy procedureand treated with cefazolin and metronidazole intravenously. Results: Preoperative proven diagnosis was achieved in 14 patients, and clinical suspicion dominated in 29 patients. The chief complaint was a sudden abdominal pain.Fever was reported in 43 patients, leukocytosis in 39 patients. Ultrasound detected 14 cases, suspected 9, and was inconclusive in 20 patients. 39 patients were treated through a laterally extended gridiron incision while 4 had a conversion to midline laparotomy. Postoperative morbidity and mortality rates were 0%. Conclusion: When subhepatic anatomical location of the appendix makes it difficult to diagnose acute appendicitis in the emergency setting, then a high level of clinical suspicion, prompt decision to operate, and skillful surgical approach could make a difference in the outcome of managing subhepatic acute appendicitis, and help to achieve zero postoperative morbidity and mortality.
Keywords: Acute appendicitis, Subhepatic appendicitis, Open appendectomy
Bader Hamza Shirah, Hamza Assad Shirah, Wael Awad Alhaidari, Omer Elhag Abdulbagi. CHALLENGES IN THE MANAGEMENT OF SUBHEPATIC ACUTE APPENDICITIS IN THE EMERGENCY SETTING International Journal of Current Research and Review. Vol 08 Issue 06, March, 47-52
1. Ball CG, Kortbeek JB, Kirkpatrick AW, Mitchell P. Laparoscopic appendectomy for complicated appendicitis: an evaluation of postoperative factors. SurgEndosc. 2004;18(6):969-73.
2. Rappaport WD, Warneke JA. Subhepatic appendicitis. Am Fam Physician. 1989;39(6):146-8.
3. Schumpelick V, Dreuw B, Ophoff K, Prescher A. Appendix and cecum. Embryology, anatomy, and surgical applications. SurgClin North Am. 2000;80(1):295-318.
4. King A. Subhepatic appendicitis. AMA Arch Surg. 1955;71(2):265-7.
5. Kulvatunyou N, Schein M. Perforated subhepatic appendicitis in the laparoscopic era. SurgEndosc. 2001;15(7):769.
6. Palanivelu C, Rangarajan M, John SJ, Senthilkumar R, Madhankumar MV. Laparoscopic appendectomy for appendicitis in uncommon situations: the advantages of a tailored approach. Singapore Med J. 2007;48(8):737-40.
7. Mwachaka P, El-busaidy H, Sinkeet S, Ogeng’o J. Variations in the position and length of the vermiform appendix in a black kenyan population. ISRN Anat. 2014;2014:871048.
8. Iqbal T, Amanullah A, Nawaz R. Pattern and positions of vermiform appendix in people of Bannu district. Gomal Journal of Medical Sciences. 2012; 10(2): 100–103.
9. Kraemer M, Franke C, Ohmann C, Yang Q. Acute appendicitis in late adulthood: incidence, presentation, and outcome. Results of a prospective multicenter acute abdominal pain study and a review of the literature. Langenbecks Arch Surg. 2000;385(7):470-81.
10. Kumar N, Rehmani B, Kumar A, Chug B. Subhepatic Appendicitis: A Diagnostic Dilemma. The Internet Journal of Surgery. Volume 32. Number 1.
11. Singh S, Jha AK, Sharma N, Mishra TS. A case of right upper abdominal pain misdiagnosed on computerized tomography. Malays J Med Sci. 2014;21(4):66-8.
12. Khairy G. Acute appendicitis: is removal of a normal appendix still existing and can we reduce its rate?. Saudi J Gastroenterol. 2009;15(3):167-70.
13. Althoubaity FK. Suspected acute appendicitis in female patients. Trends in diagnosis in emergency department in a University Hospital in Western region of Saudi Arabia. Saudi Med J. 2006;27(11):1667-73.
14. Zielke A, Hasse C, Sitter H, Rothmund M. Influence of ultrasound on clinical decision making in acute appendicitis: a prospective study. Eur J Surg. 1998;164(3):201-9.
15. Balthazar EJ, Rofsky NM, Zucker R. Appendicitis: the impact of computed tomography imaging on negative appendectomy and perforation rates. Am J Gastroenterol. 1998;93(5):768-71.