{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T07:16:17Z","timestamp":1788419777299,"version":"build-2803163510"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Failure to identify the appendix during laparoscopic appendectomy is uncommon but challenging. Complete subserosal embedding of the appendix-cecal complex is an exceptionally rare variant that may obscure all conventional laparoscopic landmarks. We describe this anomaly in a pediatric patient and describe a practical exploration strategy derived from this case.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 7-year-old boy presented with acute right lower quadrant pain suggestive of appendicitis. Computed tomography showed appendiceal dilatation with periappendiceal inflammation. During laparoscopic appendectomy, the appendix could not be identified despite tracing the teniae coli and complete cecal mobilization. A targeted serosal incision at the teniae convergence revealed a completely embedded appendix-cecal complex. Subserosal dissection and appendectomy were completed successfully (operative time 45\u2005min, blood loss 2\u2005mL). Histopathology confirmed acute suppurative appendicitis. The patient recovered uneventfully with 6-month asymptomatic follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Complete subserosal embedding of the appendix-cecal complex is a rare variant presenting as a non-visualized appendix. Systematic exploration and awareness of unusual anatomical variants are essential. Targeted serosal incision may facilitate safe laparoscopic management and avoid unnecessary conversion to open surgery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fsurg.2026.1914887","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:42:35Z","timestamp":1788417755000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Complete subserosal embedding of the appendix-cecal complex presenting as a non-visualized appendix during pediatric laparoscopic appendectomy: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Guanghua","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of General Surgery, Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ming","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"You","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongqiang","family":"Bian","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jun","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Wuhan Children\u2019s Hospital, Tongji Medical College, Huazhong University of Science and Technology","place":["Wuhan, Hubei, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"910","DOI":"10.1093\/oxfordjournals.aje.a115734","article-title":"The epidemiology of appendicitis and appendectomy in the United States","volume":"132","author":"Addiss","year":"1990","journal-title":"Am J Epidemiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1186\/s13017-020-00306-3","article-title":"Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines","volume":"15","author":"Di Saverio","year":"2020","journal-title":"World J Emerg Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1002\/ca.23474","article-title":"Variations and morphometric features of the vermiform appendix: a systematic review and meta-analysis of 114,080 subjects with clinical implications","volume":"33","author":"Kacprzyk","year":"2020","journal-title":"Clin Anat"},{"key":"B4","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1007\/s00276-017-1890-3","article-title":"Intracecal appendix: an extremely rare anatomical variation. A case report and review of literature","volume":"40","author":"Chauhan","year":"2018","journal-title":"Surg Radiol Anat"},{"key":"B5","doi-asserted-by":"publisher","first-page":"e14451","DOI":"10.7759\/cureus.14451","article-title":"Literature review of anatomical variations: clinical significance, identification approach, and teaching strategies","volume":"13","author":"Alraddadi","year":"2021","journal-title":"Cureus"},{"key":"B6","doi-asserted-by":"publisher","first-page":"107726","DOI":"10.1016\/j.ijscr.2022.107726","article-title":"A peculiar appendix: a case report","volume":"99","author":"Munasinghe","year":"2022","journal-title":"Int J Surg Case Rep"},{"key":"B7","doi-asserted-by":"publisher","first-page":"421","DOI":"10.1186\/s12893-021-01429-3","article-title":"Incidental neuroendocrine tumor of a complete subserosal appendix: an unusual presentation of a rare anatomical variation. A case report and review of literature","volume":"21","author":"Ca\u00f1izares Quisigui\u00f1a","year":"2021","journal-title":"BMC Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"110540","DOI":"10.1016\/j.ijscr.2024.110540","article-title":"Acute appendicitis in a patient with sub-hepatic, sub-serosal, and retroperitoneal location. An intraoperative management challenge","volume":"125","author":"Teferi","year":"2024","journal-title":"Int J Surg Case Rep"},{"key":"B9","doi-asserted-by":"publisher","first-page":"86","DOI":"10.1016\/j.ijsu.2006.01.016","article-title":"Subserosal appendicular stripping","volume":"5","author":"Sebastian","year":"2007","journal-title":"Int J Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1007\/BF02553380","article-title":"Vermiform appendix located within the cecal wall. Anomalies and bizarre locations","volume":"26","author":"Abramson","year":"1983","journal-title":"Dis Colon Rectum"},{"key":"B11","doi-asserted-by":"publisher","first-page":"e1","DOI":"10.5114\/pjr.2018.81158","article-title":"A pictorial essay of the most atypical variants of the vermiform appendix position in computed tomography with their possible clinical implications","volume":"84","author":"Zacharzewska-Gondek","year":"2019","journal-title":"Pol J Radiol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"269","DOI":"10.1007\/s00383-016-3990-2","article-title":"Pediatric appendicitis: state of the art review","volume":"33","author":"Rentea","year":"2017","journal-title":"Pediatr Surg Int"},{"key":"B13","doi-asserted-by":"publisher","first-page":"835","DOI":"10.1007\/s13304-025-02172-7","article-title":"Mesoappendix position variations in laparoscopic appendicectomy; a new anatomical classification to guide surgical strategy","volume":"77","author":"Cheng","year":"2025","journal-title":"Updates Surg"},{"key":"B14","doi-asserted-by":"publisher","first-page":"3872","DOI":"10.3390\/cancers15153872","article-title":"The vermiform appendix and its pathologies","volume":"15","author":"Constantin","year":"2023","journal-title":"Cancers (Basel)"},{"key":"B15","doi-asserted-by":"publisher","first-page":"1256256","DOI":"10.3389\/fsurg.2023.1256256","article-title":"The safety and efficacy of laparoscopic retrograde appendicectomy, base-to-tip approach","volume":"10","author":"Ko","year":"2023","journal-title":"Front Surg"},{"key":"B16","doi-asserted-by":"publisher","first-page":"356","DOI":"10.1186\/s12887-025-05630-8","article-title":"Outcomes of laparoscopic appendectomy of a normally appearing appendix in children with suspected acute appendicitis: a tertiary care center experience","volume":"25","author":"Abosena","year":"2025","journal-title":"BMC Pediatr"}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1914887\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T06:42:36Z","timestamp":1788417756000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2026.1914887\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":16,"alternative-id":["10.3389\/fsurg.2026.1914887"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2026.1914887","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"1914887"}}