Subhepatic appendicitis is a rare anatomical variant that mimics hepatobiliary pathology, leading to diagnostic delay and technical difficulty at surgery. We describe a 69-year-old man who underwent emergency laparoscopic appendicectomy for sepsis, complicated by dense subhepatic adhesions resulting in incomplete resection and a retained appendiceal tip. Histopathological examination unexpectedly demonstrated moderately differentiated appendiceal adenocarcinoma with isolated loss of postmeiotic segregation increased 2 expression. Three weeks later, the patient re-presented with recurrent sepsis due to pyogenic liver abscesses and a hepatic lesion suspicious for metastatic disease. Multidisciplinary assessment led to radical right hemicolectomy, cholecystectomy, and limited liver resection. Final histopathology confirmed locally advanced disease with direct T4 invasion into the liver and clear (R0) margins. This case highlights the need to consider subhepatic appendicitis in unexplained right upper quadrant sepsis and emphasizes the importance of early multidisciplinary management when retained appendiceal tissue is suspected, as radical resection may be curative.

Subhepatic appendicitis is a particularly rare anatomical variant presenting with atypical right upper quadrant (RUQ) pain mimicking hepatobiliary pathology. This mimicry frequently leads to diagnostic delay and subsequent increased risk of complications. A 41-year-old man presented to the Emergency Department with acute RUQ pain, radiating to the back and shoulder, accompanied by constitutional and gastrointestinal symptoms. RUQ ultrasound visualized no gallbladder abnormalities; subsequent CT scan revealed a dilated appendix with a rounded tip and possible presence of an abscess. Initial surgical intervention was attempted laparoscopically; however, conversion to an open appendectomy was required due to the complex anatomy, including a subhepatic cecum adhered to the retroperitoneum, and intraoperative bleeding. The cecal caput was divided to preserve the ileocecal valve. Pathological assessment was consistent with appendicitis with rupture due to postinflammatory changes. The postoperative course was largely uncomplicated with transient ileus, and the patient was discharged on postoperative day 3. Although subhepatic appendicitis is rare, it should be considered when patients present with RUQ pain and hepatobiliary assessment proves negative. In case of a nondiagnostic ultrasound, CT imaging should be employed early in the diagnostic exploration. As conversion from a laparoscopic to an open approach may be warranted in these cases, the surgical team should be vigilant when encountering such a patient.

De Garengeot hernia, characterized by the presence of the vermiform appendix within the femoral hernia sac, is a rare condition often diagnosed only intraoperatively. The incidence of acute appendicitis within a De Garengeot hernia is even more uncommon, and its clinical presentation may be atypical, making preoperative diagnosis difficult. This report describes the case of a 67-year-old male patient with multiple comorbidities, including an abdominal aortic aneurysm, who presented with right inguinal pain and bulging, culminating in the intraoperative diagnosis of a De Garengeot hernia with acute appendicitis and tip necrosis. The surgical approach involved appendectomy and hernia repair without mesh due to the risk of infection. The patient evolved favorably, highlighting the importance of high clinical suspicion and appropriate surgical management for this rare and potentially serious condition.

Background/Objectives: Small intestine and vermiform appendix lengths are critical anatomical parameters with significant implications for bariatric surgery, transplantation, and the management of short bowel syndrome. However, reliable normative data derived from direct in vivo measurements in healthy individuals remain limited. This study aimed to establish reference values in a homogeneous cohort of healthy living liver donors and to investigate the potential anatomical and functional correlation between these two structures based on their shared embryological origin and immunological roles. Methods: Data from 99 healthy living liver donors representing a multi-ethnic population were analyzed. Intraoperative measurements were performed using a standardized surgical technique: small intestine length was measured from the ligament of Treitz to the ileocecal valve, and appendix length from the base to the tip. Relationships between morphometric measurements and anthropometric variables were evaluated. Results: The mean small intestine length was 630 ± 104.7 cm, and the mean appendix length was 84.8 ± 21.1 mm. Small intestine length was significantly greater in males (p = 0.011), while appendix length showed no sex-based difference. A weak but statistically significant positive correlation was found between small intestine length and appendix length (r = 0.237; p = 0.021). Furthermore, an appendix length ≥ 8 cm was associated with a higher probability of having a small intestine length > 600 cm. Notably, the retrocecal appendix position was observed in only 4.0% of donors, a prevalence substantially lower than that reported in appendicitis series, suggesting it may be a risk factor for inflammation. Conclusions: This study reports descriptive measurements of small intestine and appendix lengths in healthy individuals undergoing donor hepatectomy. The relationship between the appendix and the small intestine appeared weak and should be interpreted as exploratory, warranting further investigation without implications for clinical decision-making.

Endoscopic retrograde appendicitis therapy (ERAT) and its visually enhanced technique (Endoscopic direct appendicitis therapy, EDAT) represent a novel minimally invasive approach, offering advantages such as high-definition real-time visualization and precise intervention. This article reports a case of a 49-year-old male with acute appendicitis accompanied by an early abscess. CT findings suggested appendicitis with abscess formation, while EDAT exploration confirmed perforation at the appendiceal tip along with adjacent fecalith impaction, further verified by contrast imaging. During the procedure, the fecalith was extracted via EDAT, followed by irrigation of the purulent cavity and placement of a modified 7 Fr × 7 cm pancreatic stent for drainage. The patient experienced immediate symptom relief postoperatively, with serial follow-up CT scans on the procedure day, 3rd, and 7th postoperative days demonstrating gradual abscess resolution and normalized inflammatory markers, leading to discharge on day 3. A subsequent 3-month telephone follow-up revealed no recurrence of abdominal pain. This case illustrates that EDAT/ERAT can provide integrated diagnosis and definitive management for complicated appendicitis, avoiding the trauma associated with surgical intervention and offering valuable clinical insights.

Background The appendix is a vermiform structure with a variable position, length, and thickness. Imaging plays a critical role in diagnosing an inflamed appendix, with non-contrast computed tomography (NCCT) being an effective modality when ultrasound is inconclusive. This study evaluates the visibility and anatomical characteristics of a normal appendix using NCCT. Methods This retrospective descriptive study was conducted in the Radiology Unit of Teaching Hospital Jaffna, in Jaffna, Sri Lanka, from September 2023 to February 2024, following approval from the Institutional Ethical Review Committee of the hospital. Two hundred individuals were evaluated (past appendectomy patients were excluded). IBM SPSS Statistics software, version 26 (IBM Corp., Armonk, NY, USA) was used, with significance assessed at P ≤ 0.05.  Results Males were 64.5%. The visibility rate was 89%. The most common positions were retrocecal (27.5%), retroileal (22%), and pelvic (21.5%). The mean length was 7.5 cm, with a base diameter of 6.6 mm, a mid-section of 6.2 mm, and a tip of 5.8 mm. Mean wall thickness was 2.6 mm, fecoliths were found in 15% of cases, and the mean distance of the base from McBurney's point was 3.32 cm. Conclusion NCCT can be used to assess the morphology, position, and presence of fecolith in equivocal cases of suspected appendicitis when ultrasound is inconclusive and contrast is contraindicated. The appendicular diameter and wall thickness can be used as evidence of inflammation. McBurney's point is a reliable anatomical guide during open appendicectomies. The presence of a fecalith itself is not a reliable indicator of appendicitis.

We report a case of acute appendicitis secondary to Taenia saginata infection. A young male presented with 17-hour migratory right lower quadrant pain. He had long-term residency in an agro-pastoral area and habits of consuming unboiled water and raw meat. Physical examination showed positive peritoneal irritation signs. Routine blood tests revealed elevated white blood cell count and normal eosinophil count; fecal routine was unremarkable. Abdominal ultrasound suggested acute appendicitis. Intraoperatively, the appendix was congested and edematous, with its tip wrapped by the greater omentum and a small amount of intra-abdominal pus. Transection with an ultrasonic scalpel expelled two yellowish-white, spontaneously wriggling flat tissues, identified as tapeworms. Resected appendix incision revealed two 1.0 cm-diameter fecaliths and 15 2.5 cm-long worms. Diagnosis was confirmed via parasite morphological identification and epidemiological history. Postoperative deworming with albendazole (400 mg/day for 3 days) was administered, with uneventful 3-month follow-up. Taeniasis is a foodborne parasitic disease, and acute appendicitis caused by it is uncommon. This detailed report of admitted cases aims to share diagnosis and treatment experience among medical institutions, improve clinicians' ability to identify "parasitic appendicitis", reduce diagnostic and therapeutic delays, and provide real-world evidence for research on the association between parasitic diseases and acute abdomen.

A male patient in the late teens presented with intermittent right iliac fossa pain associated with fever and raised inflammatory markers following a previous episode of conservatively managed appendiceal mass and was treated for recurrent acute appendicitis. The patient was managed with intravenous antibiotics and underwent an appendicectomy. The histology of the specimen reported an appendix with perforation at the tip and surrounding congestion with associated malignant tumour involving the entire length of the appendix, and further testing showed signs in keeping with a diagnosis of high-grade B-cell non-Hodgkin lymphoma. The patient was subsequently informed of the underlying diagnosis following his management for appendicitis and underwent chemotherapy.

Acute appendicitis remains one of the most common causes of acute surgical abdomen. Variations in the anatomical position of the appendix can result in atypical clinical presentations with a variety of differential diagnoses and different diagnostic pathways being followed. This can ultimately lead to diagnostic delays with associated risks of increased complications. Subhepatic appendicitis is an exceptionally rare anatomical variant of acute appendicitis. We present the case of a 31-year-old female who reported symptoms of appendicitis but had a prior history of recurrent right upper quadrant (RUQ) pain in the absence of biliary pathology. Preoperative computed tomography (CT) of this lady revealed a long retrocecal appendix with its inflamed distal tip extending into the subhepatic space. CT imaging proved critical in identifying the cause of pain and the unusual anatomical position, thereby avoiding a potential missed diagnosis on ultrasound. Although rare, subhepatic appendicitis should be considered in patients presenting with right upper quadrant or atypical abdominal pains, especially when more common differentials, such as biliary disease, have been excluded. The patient underwent an uneventful laparoscopic appendectomy using a standard three-port technique without modification. We conclude that a high index of suspicion for variant positions of the appendix is required. Conventional laparoscopic port placement remains effective even in anatomical anomalies. Familiarity and experience with this approach may optimise surgical outcomes while minimising risks associated with altered techniques.

Diverticular disease of the appendix (DDA) remains a rare and poorly understood entity. We present a female patient in her 30s who initially presented for what was believed to be tip appendicitis after imaging. The patient was brought to the operating room (OR) for a laparoscopic appendectomy, and pathology, five days postoperatively, revealed acute appendicitis with DDA. While the patient's abdominal pain had resolved by this time, her case brings into question how DDA should be managed. DDA holds a greater risk of perforation and has a high association with malignancy. Given its significant association with primary appendiceal malignancy, increased risk of perforation, diverticulitis, and chronic abdominal pain, DDA should be managed with a simple appendectomy when identified intraoperatively. The majority of cases are identified intra- or postoperatively. Future directions include whether a hemicolectomy should be performed if DDA is found. However, failure of early identification remains a current clinical weakness.