Rationale:We present a case of appendicitis with an uncommon course due to rare anatomical location of the appendix in the right retroperitoneal space below the diaphragm and above the liver.Patient’s concern:A 32-ye...Rationale:We present a case of appendicitis with an uncommon course due to rare anatomical location of the appendix in the right retroperitoneal space below the diaphragm and above the liver.Patient’s concern:A 32-year-old,previously healthy male with a history of congenital diaphragmatic hernia repair in childhood,presented with 3 days of mild,colicky,central abdominal pain associated with fever,nausea and vomiting.At presentation,pain was localized to the right lower quadrant.Diagnosis:Even though diagnosis of appendicitis was clear,we decided to confirm it with computer tomography(CT).CT revealed elevation of the right dome of the diaphragm and perforated appendix located above the liver.Intervention:Appendectomy was performed via right subcostal approach instead of usual incision in the right lower quadrant.Outcome:Patient recovered well and was discharged on the 5th day after operation.Lessons:Previous congenital diaphragmatic hermia repair may change the location of the appendix.The appendix at rare locations could lead to an uncommon course of appendicitis.On this very note,surgeons should have a high index of suspicion,and CT may help avoid inadvertent complications.展开更多
文摘Rationale:We present a case of appendicitis with an uncommon course due to rare anatomical location of the appendix in the right retroperitoneal space below the diaphragm and above the liver.Patient’s concern:A 32-year-old,previously healthy male with a history of congenital diaphragmatic hernia repair in childhood,presented with 3 days of mild,colicky,central abdominal pain associated with fever,nausea and vomiting.At presentation,pain was localized to the right lower quadrant.Diagnosis:Even though diagnosis of appendicitis was clear,we decided to confirm it with computer tomography(CT).CT revealed elevation of the right dome of the diaphragm and perforated appendix located above the liver.Intervention:Appendectomy was performed via right subcostal approach instead of usual incision in the right lower quadrant.Outcome:Patient recovered well and was discharged on the 5th day after operation.Lessons:Previous congenital diaphragmatic hermia repair may change the location of the appendix.The appendix at rare locations could lead to an uncommon course of appendicitis.On this very note,surgeons should have a high index of suspicion,and CT may help avoid inadvertent complications.
