{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T17:08:59Z","timestamp":1788455339980,"version":"build-2803163510"},"reference-count":10,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"C","license":[{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2024,12,1]],"date-time":"2024-12-01T00:00:00Z","timestamp":1733011200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2024,10,28]],"date-time":"2024-10-28T00:00:00Z","timestamp":1730073600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Appendicitis in patients with a sub-hepatic and retroperitoneal position is rare, often leading to delayed diagnosis and management due to its atypical presentation. A high index of clinical suspicion and the use of imaging modalities can improve the outcomes of patients with sub-hepatic appendicitis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation:<\/jats:title>\n                    <jats:p>A 20-year-old male presented with 36 h duration of right-sided abdominal pain, accompanied by nausea, vomiting, anorexia, and fever. He exhibited tachycardia and right lower quadrant abdominal tenderness. Laboratory tests revealed leukocytosis with a left shift and ultrasound showed simple appendicitis. An open appendectomy revealed a retroperitoneal, sub-hepatic, and sub-serosal inflamed appendix. The patient's postoperative course was uneventful.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical discussion:<\/jats:title>\n                    <jats:p>Sub-hepatic position of the appendix is rare accounting for 0.08 % of all cases of acute appendicitis. It is associated with mid-gut mal-rotation or arrested cecal descent during embryogenesis. Patients with sub-hepatic appendicitis usually have atypical presentation mimicking hepatobiliary pathologies which will lead to a delayed diagnosis and management. The standard management of sub-hepatic, retroperitoneal, and sub-serosal appendicitis relies on a laparoscopic approach however in case of difficulty and resource limitation, open appendectomy is the ultimate option.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Sub-hepatic retroperitoneal and sub-serosal appendicitis, though rare, should be included in the differential diagnosis for patients with atypical abdominal pain. A high index of clinical suspicion, use of imaging modalities, and meticulous dissection with adequate exposure are crucial for a successful outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Highlights<\/jats:title>\n                  <\/jats:sec>","DOI":"10.1016\/j.ijscr.2024.110540","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T16:18:40Z","timestamp":1730305120000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":5,"title":["Acute appendicitis in a patient with sub-hepatic, sub-serosal, and retroperitoneal location. An intraoperative management challenge"],"prefix":"10.1097","volume":"125","author":[{"given":"Dagmawi Anteneh","family":"Teferi","sequence":"first","affiliation":[{"name":"Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanko","family":"Gebru","sequence":"additional","affiliation":[{"name":"Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander Tewodros","family":"Kassa","sequence":"additional","affiliation":[{"name":"Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helina Amare","family":"Abebe","sequence":"additional","affiliation":[{"name":"Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solomon Fekadu","family":"Yehualawork","sequence":"additional","affiliation":[{"name":"Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wubhareg Anteneh","family":"Teferi","sequence":"additional","affiliation":[{"name":"Butajira General Hospital, Butajira, Central Region, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"4","key":"R1-63-20260423","first-page":"66","article-title":"A case of right upper abdominal pain misdiagnosed on computerized tomography","volume":"21","author":"Singh,","year":"2014","journal-title":"Malays. 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Surg."},{"issue":"1","key":"R10-63-20260423","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1186\/s40001-023-01059-w","article-title":"Acute appendicitis and situs viscerum inversus: radiological and surgical approach-a systematic review","volume":"28","author":"Di Buono,","year":"2023","journal-title":"Eur. J. Med. Res."},{"issue":"1","key":"R11-63-20260423","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1186\/s13256-020-02499-2","article-title":"Surgical management of subhepatic perforated appendicitis: a case report","volume":"14","author":"Hakim,","year":"2020","journal-title":"J Med Case Reports"},{"issue":"2","key":"R12-63-20260423","doi-asserted-by":"crossref","DOI":"10.1093\/jscr\/rjae069","article-title":"Management of retroperitoneal appendiceal perforation: a case report","volume":"2024","author":"Li,","year":"2024","journal-title":"J. Surg. 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