Subhepatic Klebsiella Appendicular Abscess Presenting as a Vague Abdominal Pain in a 10-Year-Old Girl

5^th World Congress on Surgery

June 25-26, 2025 | Webinar

Dr. Kaushik N R

Bharani Clinic, Madurai, India

Scientific Tracks Abstracts: Surgery

Abstract :

Statement of the Problem: Appendicitis, while common, may pose a diagnostic challenge due to atypical anatomical positions such as subhepatic location, especially in the pediatric population. Subhepatic appendicitis is a rare presentation that mimics other upper abdominal conditions, delaying diagnosis and increasing the risk of complications such as abscess formation. This case report discusses a 10-year-old girl who presented with vague abdominal pain and was later diagnosed with a subhepatic appendicular abscess caused by Klebsiella pneumoniae. Methodology & Theoretical Orientation: This case was managed in a primary care setting followed by surgical intervention. Initial symptoms included vague diffuse pain, nausea, and low-grade fever. Investigations included ultrasonography and CT which revealed a retrocecal and subhepatic perforated appendicitis with abscess formation. Laparoscopic peritoneal lavage and abscess drainage were performed. Findings: The pus culture grew Klebsiella pneumoniae with extended spectrum beta-lactamase activity, a rare pathogen for appendicular abscesses in children. Postoperative recovery was uneventful, with the child discharged in stable condition. The diagnosis was challenging due to the lack of localized signs and the subacute presentation. Conclusion & Significance: This case highlights the importance of early imaging in atypical presentations of abdominal pain in children and the need for awareness of anatomical variations. Timely diagnosis and intervention are essential to prevent serious complications. Clinicians should consider subhepatic appendicitis as a differential in pediatric patients presenting with vague upper abdominal pain.

Biography :

Kaushik N R is a dedicated medical graduate from Madras Medical College with a keen interest in pediatric and surgical care. He has extensive clinical exposure through rotations across multiple specialties and hands-on experience at Bharani Clinic under Dr. N P Rameshbabu. He has coauthored peer-reviewed publications and led quality improvement initiatives, particularly focusing on documentation and patient safety. With over 100 online teaching sessions conducted, he also holds a ‘Teach the Trainer’ certification. His case report on subhepatic appendicitis adds to the scarce literature in pediatric surgical presentations. He is currently preparing for MRCS and is passionate about clinical research, education, and improving patient outcomes.