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Pediatric subhepatic appendicitis with elevated lipase

  • Scott A. McAninch
    Correspondence
    Corresponding author at: Scott and White Medical Center - Temple, Department of Emergency Medicine, 2401 South 31st Street, Temple, Texas 76508, United States of America.
    Affiliations
    Baylor Scott and White Health, Central Region, Department of Emergency Medicine, Texas A&M Health Science Center, College of Medicine, Temple, TX, United States of America
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  • Austin Essenburg
    Affiliations
    Baylor Scott and White Health, Central Region, Department of Emergency Medicine, Texas A&M Health Science Center, College of Medicine, Temple, TX, United States of America
    Search for articles by this author
Published:October 22, 2018DOI:https://doi.org/10.1016/j.ajem.2018.09.039

      Abstract

      Appendicitis is the most common surgical emergency in children, of which most are located in the retrocecal space or pelvis. Appendicitis occurring in the subhepatic space is uncommon and may present with atypical features such as right upper quadrant pain, leading to delayed diagnosis and complications. We present a rare case of subhepatic appendicitis in an 11-year-old female, who presented with a three-day history of both right upper quadrant (RUQ) and right lower quadrant (RLQ) abdominal pain and serum lipase elevated four times the upper normal limit. The abdominal ultrasound was normal, except for prominent RLQ abdominal lymph nodes. Hours later, a computed tomography scan revealed a non-ruptured subhepatic appendicitis and normal pancreas. Our patient encounter demonstrates the need to be aware of the atypical presentations of pediatric appendicitis in general and subhepatic appendicitis in particular. Moreover, to our knowledge, this is the first reported case of elevated lipase (with a radiographically normal pancreas) in association with subhepatic appendicitis. Providers should be aware elevated serum lipase levels may be due to conditions other than pancreatitis and further evaluation should be considered if the elements of the clinical picture are incongruent.
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