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__ampersandsignndash;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.