A very rare case of a subhepatic appendix of 20cm length in a girl

A 6-year-old girl was consulted for an appendicular syndrome that had been evolving for 3 days. The clinical examination revealed a febrile child with a temperature of 39°C and a tacchycardia. Abdominal examination revealed right hypochondrium defense and deep tenderness of the right flank and right iliac fossa. The biological work-up showed a predominantly neutrophilic hyperleukocytosis. Abdominal ultrasound revealed a subhepatic appendix 9 mm in diameter associated with a well-limited hypoechoic collection in the right hypochondrium 4 cm in length with no obvious stercolith. Surgical exploration revealed a sub-hepatic and subserosal appendix of 20 cm in length, which is a very rare anatomical variant and underlines the need to verify the convergence of the 3 caecal bands to determine the exact site of the appendicular base. The risk is to leave an appendicular stump in place.