Abduletif Haji Ababor Abagojam ^1,2 Remedan Jemal Dekema ^1,2 Jafer Yasin Mohammed ^2,3 Kedir Negesso Tukeni ^1,2,4*

• ¹ Jimma University, Jimma, Oromia, Ethiopia
• ² Odahulle General Hospital, Jimma Ethiopia, Jimma, Ethiopia
• ³ Careland General Hospital, Finfinne/Furi, Ethiopia
• ⁴ Department of Internal Medicine, Jimma University, Jimma, Ethiopia

The appendix is a small, tube-shaped organ that connects to the large intestine. Though its role is unknown, it can get infected, resulting in acute appendicitis, which, if not detected and treated early, can lead to serious consequences. Though the symptoms and signs of acute appendicitis are straightforward in most cases, atypical locations might result in unexpected presentations, which can lead to complications as it might not be detected and treated early. This case report describes a 27-year-old black Ethiopian male patient who presented with right upper abdominal pain, low grade fever, palpitations, and diarrhea. He also had some episodes of vomiting of ingested matter. Upon physical examination, the patient looks acutely sick with some degree of tachycardia. Abdominal examination revealed right upper abdominal quadrant tenderness, though there was no any palpable mass noted. Laboratory investigations were unremarkable apart from the stool examinations which revealed many puss and red blood cells, and full of actively motile bacteria. Abdominal ultrasound showed enlarged subhepatic appendix with internal 1cm depth fecolith, that was partially compressible, with no obvious peri appendiceal free fluid or other pathology. The assessment of subhepatic acute appendicitis was entertained and emergency operation was done which revealed inflamed subhepatic appendix which was at verge of rupture. On subsequent follow up, the patient significantly improved evidenced by disappearance of symptoms including abdominal pain, fever or palpitation. Subhepatic appendix is a rare condition caused by either nondescent of the caecum or intestinal malrotation during early development. As its presentation is not classical and hence mimics other pathology, the diagnosis may be overlooked, resulting in perforation and abscess formation, leading to increased morbidity, and possibly mortality. A high level of suspicion is required for early diagnosis and treatment to improve patient outcomes.