Hepato‐Diaphragmatic Interposition of the Cecum: A Rare Variant

The cecum is a blind intestinal pouch usually situated in the right iliac fossa. Malrotation of gut causes congenital abnormalities of the intestines such as the subhepatic cecum. The antero‐hepatic location of the cecum which is unique among the described variations with the Chilaiditi sign makes this case report of high relevance for liver and intestinal procedures. During routine dissection of the abdomen of an 89‐year‐old male cadaver, a rare variant location of the cecum was found. Further dissection of the cecum, large intestines, liver, gallbladder and their blood supply was performed, and the specimen was photographed. The cecum with appendix, ascending colon and hepatic flexure was present on the upper right quadrant, anterior to the right lobe of the liver and gallbladder leaving an impression on the right lobe. The ascending colon was short. The arterial supply to the antero‐hepatic cecum was from the ileocolic, the terminal branch of the superior mesenteric artery and it was directed towards the right hypochondrium. The rare antero‐hepatic interposition of the cecum should be known to gastroenterologists, radiologists, and surgeons because of the following reasons: Due to its position, intestinal movements could be minimized. The pain in the unusual hepatic position of the cecum and appendix could generate confusion and delay in the diagnosis and treatment of appendicitis. Also, it may lead to misinterpretation of barium enema and computed tomographic scan findings.