Difficult diagnosis of acute abdomen caused by sub hepatic caecum with acute appendicitis-A rare case report

Sub hepatic caecum and appendix is an uncommon condition. It occurs due to incomplete rotation of foetal foregut and mal descent of caecum. This condition may be mistaken for acute cholecystitis, liver abscess, duodenal perforation or right renal calculus. Diagnosis may be delayed when acute appendicitis develops complications - appendicular rupture, perforation or localized abscess. The condition may be missed on ultra sound and CT abdomen may be inconclusive. Thus, surgeon should have a high index of suspicion in such undiagnosed right upper abdominal pain. In such cases an early diagnostic laparoscopy is suggested to avoid further complications. The present case is being reported due to difficulty in diagnosis of the condition, need for timely surgical intervention to avoid life threatening complications.