Right Iliac Fossa Pain
Introduction – Right iliac fossa (RIF) pain is one of the most common presentations to acute general surgical services.1 Causes include appendicitis, other gastrointestinal, urological, gynaecological, vascular and musculoskeletal pathologies. Given this range of potential pathologies, variation in presentation and similarity to other conditions, particularly ovarian pathologies in women of reproductive age, diagnosing appendicitis can be a challenge.2 Traditionally, surgeons have relied on clinical history, examination findings and basic laboratory investigations for diagnosis.
Objective stratifiers such as the Appendicitis Inflammatory Response (AIR) 3 and Alvarado scores 4 have been developed to combat this diagnostic uncertainty; yet, these derived from small retrospective cohorts, are poorly validated, and not widely used.5 Since delayed appendicectomy is associated with increased risk of complications, prompt diagnosis and treatment is essential.6 Diagnostic uncertainty, coupled with the risks of diagnostic delay, has led to surgeons having a low threshold for operating on patients with equivocal symptoms resulting in high rates of negative appendicectomy: a national audit in 2012 found the UK’s negative appendicectomy rate to be 20.6%.7 8 Recent guidelines stipulate that appendicectomy should be performed laparoscopically unless this is contraindicated 9 10 ( table 1 ).
However, in 2012 one-third of patients underwent open appendicectomy.7 Unlike laparoscopic surgery, open procedures typically commit the surgeon to proceed to appendicectomy even if the appendix is found to be macroscopically normal once visualised.8
- 1 What are the differential diagnoses for right iliac fossa pain?
- 2 What causes right hypochondrium pain?
- 3 What is a hernia in the right iliac fossa?
- 4 What is the role of ultrasound in right iliac fossa pain?
- 5 How do you rule out appendicitis?
- 6 Can appendicitis pain come and go for months?
- 7 How long can your appendix hurt before it gets bad?
- 8 Can you have mild appendicitis?
- 9 What organs are in the iliac fossa?
What organ is in the right iliac fossa?
A natomy – The large intestine originates at the cecum in the right iliac fossa and continues in the retroperitoneum as the ascending colon. At the hepatic flexure, it becomes intraperitoneal and crosses the abdomen to again become retroperitoneal at the splenic flexure.
- In the left iliac fossa, it again becomes intraperitoneal, curving on itself as the sigmoid colon.
- The rectum begins at the sacrum, with the anterior portion covered by the peritoneum, and terminates at the anus.
- Given the proximity of the sigmoid colon and rectum to the uterus and prostate, these structures are especially subject to acute and late effects of radiation treatment.
Within the pelvis, anatomic areas of interest include the mesorectum, the presacral space, and the lateral, inferior, and anterior pelvic spaces. The mesorectum is a cylindrical structure consisting of adipose tissue that contains lymphovascular and neural structures, and it is encapsulated by the mesorectal fascia.
- With cone-shaped tips in the cranial-caudal direction, the mesorectum starts at the level of the sacral promontory at the origin of the superior rectal artery and ends where the levator ani muscle inserts into the rectal wall.
- The presacral space is a triangular area enclosed posteriorly by the presacral (Waldeyer’s) fascia and anteriorly by the mesorectal fascia.
The presacral space contains the median and lateral sacral vessels, the presacral lymphatic chains, the anterior branches of the sacral nerves, and the inferior hypogastric plexus. The lateral pelvic space encompasses the lateral aspect of the mesorectal fascia and includes the lateral pelvic sidewalls.
What are the differential diagnoses for right iliac fossa pain?
What are the differential diagnoses for abdominal pain by region? Learn how to make differential diagnoses based on the regional location of your patient’s abdominal pain. Let’s break down the most common differential diagnoses for abdominal pain by the nine abdominal regions.
- Eep in mind that both the anatomical regions and quadrants of the abdomen are helpful when correlating anatomical structures within those areas.
- You can choose which you prefer to use (e.g., regions or quadrants) since both are used throughout medical terminology.
- But, in this article we will use the nine anatomical regions.
In the right hypochondriac region, pain and tenderness can be associated with gallbladder diseases such as cholelithiasis or cholecystitis. These patients can present with right upper quadrant (RUQ) pain after eating fatty foods. Duodenal ulcers are associated with pain in the RUQ and right hypochondriac region.
- Classically, this pain decreases with food or antacids.
- Hepatitis and other hepatobiliary diseases such as cirrhosis, hepatoma (e.g., cancer of the liver), or cholangitis (e.g., infection of the bile duct system) also present with pain and tenderness in this region.
- They are often associated with elevated bilirubin, jaundice, and scleral icterus.
Figure 1. Differential diagnoses for pain in the right hypochondriac region include gallbladder diseases (cholelithiasis or cholecystitis), duodenal ulcers, hepatitis, and hepatobiliary diseases (cirrhosis, hepatoma, or cholangitis). Pain and tenderness in the epigastrium may be associated with gastroesophageal reflux disease (GERD) and gastritis.
- These often present with heartburn, regurgitation, coughing, and even chest pain.
- Gastric ulcers can also cause pain in the epigastric region.
- Classically, the pain is greater with food and is not relieved by antacids.
- Pancreatitis often presents with epigastric pain associated with nausea, vomiting, and anorexia.
Common causes of pancreatitis include gallstones, alcohol abuse, and hyperlipidemia. So, be sure to screen for these disorders in your history questions when a patient presents with epigastric pain. Figure 2. Differential diagnoses common to the epigastric region include gastroesophageal reflux disease (GERD), gastritis, gastric ulcers, and pancreatitis.
Pain in the left hypochondriac region can occur with GERD, gastritis, or gastric ulcers. As well, a splenic rupture, cyst, or other diseases of splenic etiology can present with pain in this region—which often radiates to the back. These diseases may also involve anemia of thrombotic origin which can lead to a physical exam finding of splenomegaly.
Figure 3. Differential diagnoses common to the left hypochondriac region include gastroesophageal reflux disease (GERD), gastritis, gastric ulcers, and diseases of the spleen (e.g., splenic rupture or cyst). Pain in the right lumbar region can be related to hepatitis or even mesenteric ischemia affecting the loops of the small bowels.
Patients often present with pain that seems out of proportion to the exam. The etiology of mesenteric ischemia is often vascular in nature and can be embolic, thrombotic, or nonocclusive ischemia. Embolic ischemia is usually a sudden onset of pain, while thrombotic and nonocclusive ischemia pain can be chronic or gradual in development.
Inflammatory bowel diseases such as Crohn’s disease often affects the terminal ileum first, which is why it can also present as pain in the right lumbar region. These patients often present with diarrhea and weight loss as well. A patient with small bowel obstruction often presents with pain, nausea, vomiting, and a lack of bowel movements and flatus.
- Pertinent history questions can help identify previous surgeries that may be the cause of common etiologies such as adhesions, hernias, or masses. Figure 4.
- Differential diagnoses common to pain in the right lumbar region include hepatitis, mesenteric ischemia, inflammatory bowel disease, and small bowel obstruction.
Pain in the umbilical region may be associated with pancreatitis or peptic ulcer disease, including gastric and duodenal ulcers. It may also be associated with mesenteric ischemia or small bowel obstruction. During inspection and palpation, also evaluate for an umbilical hernia.
If the hernia cannot be reduced, it is likely incarcerated and will need a surgical consult. Enteritis (e.g., inflammation of the small intestine), which may be caused by several etiologies (e.g., bacterial, viral, or autoimmune issues), can also present with umbilical region pain. These patients often present with nausea, vomiting, and diarrhea.
It is important to ask about recent meals and if any of the patient’s contacts are also sick since bacteria in contaminated foods is a common cause of enteritis. Early appendicitis can also present with periumbilical pain, which later localizes to the right lower quadrant or right iliac region.
- Figure 5. Differential diagnoses common to the umbilical region include pancreatitis, peptic ulcers, mesenteric ischemia, small bowel obstruction, umbilical hernia, enteritis, and early appendicitis.
- In the left lumbar region, you may again encounter pain of splenic etiology, mesenteric ischemia, enteritis, or small bowel obstruction.
Figure 6. Differential diagnoses common to the left lumbar region include diseases of the spleen, mesenteric ischemia, enteritis, and small bowel obstruction. Regarding the right iliac region, patients may present with an acute onset of migratory lower right quadrant pain as well as anorexia, nausea, and vomiting, which are concerning for appendicitis.
As well, right-sided inguinal hernias can present with pain in the right iliac region. The first sign is often a bulge in the inguinal region. Inspect and palpate the hernia to determine if it is incarcerated or strangulated. It may present with signs of an obstruction if the intestines are incarcerated.
If the patient has a right-sided inguinal hernia and obstructive symptoms such as nausea, vomiting, anorexia, pain, or constipation, the hernia may contain part of the cecum which is causing the obstruction. Figure 7. Differential diagnoses common to the right iliac region include appendicitis, inguinal hernia, and small bowel obstruction.
Pain in the hypogastrium (e.g., suprapubic region) could be caused by appendicitis or diverticulitis. However, diverticulitis may start with pain in the lower left quadrant if it involves the sigmoid and left colon. Ischemic colitis often presents with pain and bright red rectal bleeding from a vascular etiology such as mesenteric ischemia.
The left colon is commonly associated with ischemic colitis because of watershed areas found near the splenic flexure in the distal transverse colon and in the upper rectum. Cystitis or a urinary tract infection can also cause pain in the hypogastric region.
Figure 8. Differential diagnoses common to the hypogastric region include appendicitis, diverticulitis, ischemic colitis, cystitis, and a urinary tract infection. Pain in the left Iliac region is commonly caused by diverticulitis, an inguinal hernia, and ischemic colitis. As mentioned, the first sign of an inguinal hernia is often a bulge in the inguinal region.
If a left-sided inguinal hernia presents with symptoms such as nausea, vomiting, anorexia, pain, or constipation, the hernia may be strangulating the sigmoid colon and causing an obstruction. Inflammatory bowel disease (specifically ulcerative colitis) can also present here because it tends to affect the rectum first.
It often presents with bloody diarrhea, pain, fever, and weight loss. Figure 9. Differential diagnoses common to the left iliac region include diverticulitis, inguinal hernia, ischemic colitis, and inflammatory bowel disease (specifically ulcerative colitis). Pain in the left and right hypochondriac regions may occur with pulmonary or cardiac causes such as pneumonia, a myocardial infarction, or a pulmonary embolism.
These may also present as chest pain and shortness of breath. Figure 10. When a patient presents with pain in the left (L) and right (R) hypochondriac regions, their symptoms could have pulmonary or cardiac causes such as pneumonia, myocardial infarction, or a pulmonary embolism.
- A ruptured aortic aneurysm may present with sudden chest and abdominal pain in the epigastric and umbilical regions.
- Figure 11.
- When a patient presents with sudden pain in the epigastric and umbilical regions, it could be from a ruptured aortic aneurysm.
- Sudden and colicky flank pain in the left or right lumbar region alongside fever and / or dysuria (e.g., painful or difficult urination) can be caused by nephrolithiasis (e.g., kidney stones) or pyelonephritis (e.g., kidney infection).
Figure 12. Pain in either the left (L) or right (R) lumbar region could be caused by nephrolithiasis (e.g., kidney stones) or pyelonephritis (e.g., kidney infection). Pain in the left and right iliac regions can represent ovarian torsion or ovarian cysts in females.
Pain in these two areas can also be caused by testicular torsion in males. Figure 13. Pain in the left (L) and right (R) iliac regions can be caused by ovarian torsion, testicular torsion, or ovarian cysts. That’s it for now. If you want to improve your understanding of key concepts in medicine, and improve your clinical skills, make sure to register for a, which will give you access to free videos and downloads.
We’ll help you make the right decisions for yourself and your patients.
de Dombal, FT.1988. The OMGE acute abdominal pain survey. Progress report, 1986. Scand J Gastroenterol Suppl,144 : 35–42. Jin, XW, Slomka, J, and Blixen, CE.2002. Cultural and clinical issues in the care of Asian patients. Cleve Clin J Med,69 : 50, 53–54, 56–58. Tseng, W-S and Streltzer, J.2008. “Culture and clinical assessment”. In: Cultural Competence in Health Care, Boston: Springer. Wong, C.2020. Liver fire in traditional Chinese medicine. verywellhealth,
: What are the differential diagnoses for abdominal pain by region?
What is mild probe tenderness in right iliac fossa?
Abstract – A 27-year-old man with a background of well controlled colitis presented with a 12-hour history of central abdominal pain, nausea, vomiting and fever. A diagnostic laparoscopy revealed an extremely large, gangrenous appendix, which had descended into the pelvis posterior to adhesions in the right iliac fossa and was torted 720°.
- The decision was taken to convert to a lower midline laparotomy and as the base appeared healthy, a standard appendicectomy was performed.
- The patient recovered well and was discharged after two days.
- The appendix measured 104mm x 53mm x 51mm.
- Histology revealed acute haemorrhagic and necrotising appendicitis with foci of impending perforation.
There was no malignancy or mucocoele. Acute torsion (or volvulus) of the appendix is an unusual cause of this common general surgical emergency. Keywords: Appendix, Appendicitis, Torsion abnormality Abdominal pain with right iliac fossa tenderness is an extremely common presentation to the general surgical emergency service, with several key differential diagnoses, which may or may not require operative intervention.
What are the symptoms of right iliac fossa mass?
Retrospective Analysis of Right Iliac Fossa Mass: A Single-Center Study Monitoring Editor: Alexander Muacevic and John R Adler 1 Department of General Surgery, Government Medical College & Hospital, Sundargarh, IND Find articles by 2 Department of Anesthesiology, Saheed Laxman Nayak (SLN) Medical College & Hospital, Koraput, IND Find articles by 3 Department of Anatomy, Government Medical College & Hospital, Sundargarh, IND Find articles by 1 Department of General Surgery, Government Medical College & Hospital, Sundargarh, IND 4 Department of General Surgery, Bhima Bhoi Medical College & Hospital, Balangir, IND Find articles by © 2022, Behera et al.
- This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
- Background Right iliac fossa mass is one of the most common clinical scenarios a surgeon encounters during their surgical practice.
It poses a critical diagnostic dilemma for surgeons and requires considerable diagnostic skills. Its clinical diagnosis becomes difficult in the presence of comorbidities, such as severe obesity and guarding, as in these cases, the mass becomes palpable only upon the administration of a relaxant.
- Methods A total of 108 patients admitted to Bhima Bhoi Medical College & Hospital, exhibiting signs and symptoms of mass in the right iliac fossa upon cross-examination, were included in the study.
- We recorded their detailed clinical history and performed physical examinations, including erect abdomen, chest (post-anterior view), and contrast x-rays, ultrasonogram; and CT scans.
Results In this study, patients with appendicular masses, appendicular abscesses, ileocecal tuberculosis, cecum carcinoma, ovarian tumors, and parietal lipoma accounted for 45.3%, 17.5%, 12.9%, 7.4%, 6.4%, and 4.6% of the total cases, respectively, whereas patients with retroperitoneal tumors, parietal abscesses, and ileocecal lymphadenopathy accounted for 1.8% each.
Keywords: tubo-ovarian mass, carcinoma cecum, ileocecal tuberculosis, appendicular lump, right iliac fossa mass Right Iliac fossa (RIF) mass, referred to as the “temple of surprises”, is a common clinical condition with a notable diagnostic dilemma for surgeons. Most patients diagnosed with a mass in the lower right abdomen are admitted to the surgery ward.
The mass can develop from parietal, intra-abdominal, or retroperitoneal structures. The common conditions that present with right iliac fossa mass are appendicular masses, tuberculosis of the ileocecal region, cecal carcinoma, iliac lymphadenitis, and adnexal or tubo-ovarian masses.
- It is very important to differentiate these conditions to reach a diagnosis and treatment plan as there is vast variability in management.
- The aim of the present study is to emphasize the well-recognized clinicopathological aspects of RIF mass in both adolescent and adult populations and its relative incidence in the region, to highlight the mainstay of treatment and its outcome.
We systemically examined the hospital database for the diagnoses of RIF mass in a tertiary care hospital in Eastern India, Bhima Bhoi Medical College & Hospital, Balangir, Odisha, between April 2018 and April 2022. A total of 108 patients admitted to the hospital presenting clinical signs and symptoms of RIF mass were included in the study.
The criteria for inclusion were patients of both genders of all age groups admitted with a mass in the RIF with or without pain and those patients with incidentally identified RIF mass after examination and investigation. Exclusion criteria were masses developing from other quadrants of the abdomen extending into the RIF, masses arising from structures that are atypically present in the RIF, and swellings arising from adjacent bones.
The detailed clinical history of each patient was recorded, along with a thorough clinical examination. Body parameters, such as complete blood count, erythrocyte sedimentation rate, random/fasting blood sugar, serum urea, creatinine, sodium, and potassium levels were noted.
Viral markers for each patient, including the human immunodeficiency virus, hepatitis C virus, and hepatitis B surface antigen were recorded. To verify the diagnosis, ultrasonography (USG) of the abdomen had been advised in all cases. In case of doubtful diagnoses, a contrast-enhanced computed tomography (CECT) scan of the abdomen was advised.
In a few cases, colonoscopy was also advised to verify the diagnosis. Appropriate bowel preparation with suitable antibiotics had been carried out when required. During open laparotomy, all intraabdominal organs were examined, in addition to specific pathological examinations.
Surgical procedures were performed according to the type of pathology identified, and postoperative care was provided as per the established protocol. Diagnoses were verified using a histopathological examination of the specimen, and follow-ups with the patients were scheduled at variable time periods.
Data were indicated as frequencies and percentages and analyzed using Microsoft Office Excel 2013 (Microsoft Corporation, Redmond, Washington, United States) and SPSS for Windows, Version 16.0 (Released 2007; SPSS Inc., Chicago, United States). Moreover, a chi-square test was used to determine the association between categorical variables.
A p-value less than 0.05 was considered statistically significant. This study included 108 patients with masses in the RIF. Data were collated and analyzed and inferences were drawn. Of the total patients, 45.37% were diagnosed with appendicular masses, followed by 17.59% with appendicular abscesses, 12.96% with ileocecal tuberculosis, 7.4% with cecal carcinoma, 6.48% with ovarian tumors, 4.62% with parietal-wall lipoma, and 1.8% patients with retroperitoneal tumors, parietal-wall abscesses, and ileocecal lymphadenopathy each (Table ).
Incidence of different types of RIF mass RIF: right Iliac fossa
|Serial No.||Diagnosis||No. of cases||Percentage|
The youngest patient was an 11-year-old boy diagnosed with an appendicular lump and the eldest patient was a 65-year-old diagnosed with cecal carcinoma. Appendicular lump was the most common in the third decade of life, followed by the fourth, fifth, and sixth decades.
Additionally, an appendicular abscess was most common in the second decade; tuberculosis of the ileocecal region in the fourth decade; cecal carcinoma in the fifth, sixth, and seventh decades; ovarian tumors and parietal lipomas in the fourth decade; retroperitoneal tumors in the fifth decade; and parietal abscess and iliac lymphadenitis in the third decade of life (Table ).
|Diagnosis||No. of cases||Second Decade (11–20)||Third Decade (21–30)||Fourth Decade (31–40)||Fifth Decade (41–50)||Sixth Decade (51–60)||Seventh Decade (61–70)|
Of all diagnoses, appendicular lumps were primarily reported in males (61.22%), whereas appendicular abscesses were mostly reported in females (78.94%). In contrast, tuberculosis of the ileocecal region exhibited equal incidence among males and females.
|Appendicular lump||30 (61.22%)||19 (38.77%)|
|Appendicular abscess||4 (21.05%)||15 (78.94%)|
|Ileocecal tuberculosis||7 ( 50%)||7 (50%)|
|Cecal carcinoma||6 (75%)||2 (25%)|
|Tubo-ovarian mass||0||7 (100%)|
|Parietal lipoma||4 (80%)||1 (205)|
|Retroperitoneal mass||0||2 (100%)|
|Parietal-wall abscess||2 (100%)||0|
|Ileocecal lymphadenopathy||2 (100%)||0|
Patients with appendicular masses (49 cases) predominantly complained of abdominal pain with fever and vomiting in 36 and 32 cases, respectively. Furthermore, the total leucocyte count was high (>11,000) in all patients with appendicular mass and appendicular abscess. USG of the abdomen and pelvis was performed in all cases to confirm the diagnosis. In contrast, in Koch’s total leucocyte count was normal in all 14 cases of ileocecal tuberculosis. Moreover, USG of the abdomen and pelvis and CECT was performed for four patients who tested positive for acid-fast bacilli. Out of eight patients with cecal carcinoma, the total blood count was high in four (Table ). Signs and symptoms
|Diagnosis||No. of cases||Fever||Vomiting||Weight loss|
Conservative management was implemented in patients with an appendicular lump, according to the Ochsner-Sherren regime. Patients who did not respond to conservative management underwent early surgical intervention, with satisfactory post-operative recovery.
- Out of the 14 patients diagnosed with ileocecal tuberculosis, eight were managed conservatively and six underwent laparotomy and ileotransverse anastomosis.
- All eight patients were discharged and advised to follow an anti-tuberculosis treatment (ATT) regimen.
- All eight patients with cecal carcinoma underwent right hemicolectomy and were later referred to a tertiary cancer institute for further treatment (Tables, ).
|Diagnosis||No. of cases||Non-surgical treatment||Surgical treatment|
|Appendicular lump||49||–||49 (100%)|
|Appendicular abscess||19||–||19 (100%)|
|Ileocecal tuberculosis||14||8 (57.14%)||6 (42.85%)|
|Cecal carcinoma||8||–||8 (100%)|
|Tubo-ovarian mass||7||–||7 (100%)|
|Parietal lipoma||5||–||5 (100%)|
|Retroperitoneal mass||2||–||2 (100%)|
|Parietal-wall abscess||2||–||2 (100%)|
|Ileocecal lymphadenopathy||2||2 (100%)||–|
Type of surgical procedure
|Surgical procedure||No. of cases||Percentage|
|Extra peritoneal drainage with appendectomy||14||12.96%|
|Laparotomy and drainage of abscess||10||9.25%|
|Right ovarian cystectomy||7||6.48%|
The most common condition presenting as RIF mass was appendicular mass, followed by appendicular abscess, Ileocecal tuberculosis, and cecal carcinoma. Similar results have been reported in studies conducted by Juniorsundresh et al. and Raju et al., Appendicular mass In the present study, appendicular mass accounted for 45.37% of the cases, with pain being the most common symptom. Fever and vomiting were observed in 73.4% and 65% of patients with appendicular mass, respectively. Moreover, appendicular masses were more common in males than in females (1.57:1). Although only five patients were suspected of a mass in the abdomen, upon examination, a mass in the RIF was confirmed in all cases. According to Das et al., a patient complaining of pain four to seven days after the appearance of symptoms frequently felt a tender mass in the RIF, In this study, all patients of appendicular mass exhibited tender and firm RIF masses. According to Skoubo-Kristensen et al., 55% of the cases in their study exhibited febrile episodes with body temperatures >39 °C, In the present cohort, 73.4% of patients reported fever, whereas vomiting was experienced by 65% of the patients. According to Gahukamble et al., “in situ” delayed appendectomy was beneficial for all patients who responded positively to the initial management of appendicular mass, Skoubo et al. reported that conservative management of appendicular masses was successful in most cases, with lower complication rates than with early operative treatment, Nonetheless, according to Das et al., early appendectomy for the removal of appendicular mass was relatively safe owing to the improvements in surgical techniques and better postoperative care, It also reported that a requirement for prolonged postoperative care was observed in patients in which appendicular mass was managed conservatively compared to patients that underwent early investigations. Appendicular abscesses were observed in 17.59% of the cohort. Most of the cases were observed in the second decade, and 78.94% of patients were females. According to Bradley et al., the mean age for appendicular abscess formation was 40.7 ± 2.7 years, Ileocecal tuberculosis According to Elhence et al., although gastrointestinal tuberculosis is rare in developed countries, it is still an issue in developing countries, In this study, 12.96% of the masses in the RIF developed because of tuberculosis. Most cases were reported from rural areas, maximum incidence occurring in the fourth decade (71.4%). The male to female incidence ratio was 1:1, and all patients exhibited abdominal pain, with weight loss reported in 12 cases (85%) and fever in 50% cases. According to Kelly et al., for the diagnosis of Ileocecal tuberculosis, patients with suitable clinical features, even in absence of classical risk factors for tuberculosis, must undergo intense clinical examination, According to Malik et al., USG results can be suggestive of tuberculosis for further diagnosis under proper clinical settings, In the present study, abdominal USG was advised to all patients. A standard drug regimen was prescribed to all patients as per the Revised National Tuberculosis Control Programme (RNTCP) after confirming the diagnosis either by biopsy or after further investigation in the Department of TB & Chest. Cecal carcinoma In this study, carcinoma of the cecum was observed in 7.4% of the cases; all patients were above 40 years of age. According to Amin et al., in a study with 20 patients, the majority of the cases were in the age group of 45-65 years, with the oldest patient being 80 years old and the youngest being only 30 years old, In this study, the incidence of cecal carcinoma was higher in males (75%). According to a study by McDermott et al., 55% of patients with cecal carcinoma were males and 49% were females, According to Goligher et al., most of the patients with cecal carcinoma exhibited chronic, but not severe, abdominal pain in the RIF, while the subcostal region or epigastrium was frequently associated with localized tenderness, Richardson et al. reported that abdominal USG findings exhibited a sensitivity, specificity, and accuracy of 96%, 67%, and 91%, respectively, for the diagnosis of colonic carcinoma, In the present study, all patients were accurately diagnosed using USG. Furthermore, a colonoscopy was performed and biopsies were submitted. Considering the growth of ileocecum and ascending colon, Goligher et al. suggested a more extensive right hemicolectomy, unless the general condition of the patient required minimum dissection to ensure a reasonable likelihood of cure, Ovarian tumors In patients with tubo-ovarian mass, the most common symptoms were mass in the lower right quadrant and loss of weight. The diagnosis was mostly based on USG. In all cases, right ovarian cystectomy was performed, and the excised portion was sent for histopathological examination. Other patients in this study were diagnosed with parietal lipoma and retroperitoneal mass. In these cases, an excisional biopsy was performed, and the diagnosis was based on histopathological examination. Parietal abscesses were drained externally, while patients with iliac lymphadenopathy, confirmed using USG with guided Fine Needle Aspiration Cytology (FNAC) to be of Koch’s origin, were prescribed drugs under the ATT, as per the RNTCP. The limitations of the study include being a single-center study with a small sample size. In this study, RIF mass was most commonly reported in the age group of 20-40 years, with a higher incidence in males than in females. However, an increased incidence of appendicular abscess was reported in females. The most common symptom was abdominal pain, with pain in the RIF, fever, vomiting, and weight loss among others. Pathology of the vermiform appendix was commonly suspected as a mass in the RIF. Nonetheless, ileocecal tuberculosis was highly suspected in patients with chronic abdominal pain. No mortality was reported in this study. However, surgery was the mainstay of treatment, which presented good outcomes when performed in a proper clinical setting. The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus. The authors have declared that no competing interests exist. Consent was obtained or waived by all participants in this study Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue.1. Role of ultrasonography in pre-operative evaluation of right iliac fossa mass. Madhushankar L, Kumar SR, Sanjay SC, Laxmikanta L, Hemanth V. J Evol Med Dent Sci.2013; 2 :9030–9036.2. Evaluation of pathological nature of the right iliac fossa mass and its management. Juniorsundresh N, Narendran S, Ramanathan M. J Biomed Sci Res.2009; 1 :55–58.3. A clinical study of right iliac fossa mass. Raju B, Reddy G. Indian J Appl Res.2016; 6 :82–85.4. A retrospective analysis of conservative management versus early surgical intervention in appendicular lump. Das BB, Nayak KN, Mohanty SK, Sahoo AK. Cureus.2022; 14 :0.5. The appendiceal mass: results of conservative management. Skoubo-Kristensen E, Hvid I. Ann Surg.1982; 196 :584–587.6. Surgical and pathological basis for interval appendicectomy after resolution of appendicular mass in children. Gahukamble DB, Gahukamble LD. J Pediatr Surg.2000; 35 :424–427.7. Pseudomyxoma peritonei of appendiceal origin: a clinicopathologic analysis of 101 patients uniformly treated at a single institution, with literature review. Bradley RF, Stewart JH 4th, Russell GB, Levine EA, Geisinger KR. Am J Surg Pathol.2006; 30 :551–559.8. Abdominal tuberculosis as observed by a surgeon. Elhence IP. Ind J Tub. XXVI :58–61.9. Tuberculosis and diabetes mellitus: convergence of two epidemics. Dooley KE, Chaisson RE. Lancet Infect Dis.2009; 9 :737–746.10. Frequency of intestinal tuberculosis in cases of intestinal obstruction. Malik KA, Waheed I. J Liaquat Uni Med Health Sci.2006; 5 :119–121.11. Delay in the diagnosis and prognosis of caecal carcinoma: a study of 20 cases. Amin MA, Khan MA, Ayub M, Mahmood M, Ashraf M, Choudhry AR. J Ayub Med Coll Abbottabad.2001; 13 :28–31.12. Comparative results of surgical management of single carcinomas of the colon and rectum: a series of 1939 patients managed by one surgeon. McDermott FT, Hughes ES, Pihl E, Milne BJ, Price AB. Br J Surg.1981; 68 :850–855.13. Goligher JC, Duthie H, Nixon H. London: Bailliere Tindall. Vol.1980. London: Bailliere Tindall; 1985. Surgery of the Anus, Rectum and Colon, 5th Ed; pp.386–401.14. Abdominal ultrasonography in the diagnosis of colonic cancer. Richardson NG, Heriot AG, Kumar D, Joseph AE. Br J Surg.1998; 85 :530–533. : Retrospective Analysis of Right Iliac Fossa Mass: A Single-Center Study
Does appendicitis pain come and go?
Appendicitis typically starts with a pain in the middle of your tummy (abdomen) that may come and go. Within hours, the pain travels to the lower right-hand side, where the appendix usually lies, and becomes constant and severe. Pressing on this area, coughing, or walking may all make the pain worse.
What causes right hypochondrium pain?
Medically Reviewed by Sanjay Ponkshe on May 06, 2023 Several health conditions can cause pain in the right upper quadrant (RUQ) of your abdomen, Pain in your abdomen can be hard to diagnose because it holds so many organs. Doctors describe your abdomen in sections or quadrants to help find the organs that might be the cause of any health problems.
Liver GallbladderLarge intestineSmall intestine Stomach Pancreas Right kidney
To find your RUQ, look down at your belly and imagine a vertical line through the center. Then imagine a second horizontal line across your belly. This divides your abdomen into four sections. The upper right section near your ribs is the right upper quadrant. Depending on the organ involved, you might have many different symptoms along with the pain in your abdomen. These might include:
Fever Nausea VomitingDiarrheaSwelling in your abdomen Yellow skin Blood in your stoolTenderness in your abdomenPain when you take a breath
You might experience different kinds of pain. Most of the time, pain in your abdomen is minor and simply a discomfort. Depending on the organ and the condition, sometimes these can be serious. Severe abdominal pain, Acute and severe pain comes on very quickly.
DullVagueNauseatingHard to pinpoint
Referred pain, Sometimes problems with organs in your abdomen might cause pain in a different part of your body. For example, a problem with your gallbladder might cause pain in your abdomen but also in your right shoulder. This is called referred pain,
Somatic pain. This kind of pain comes from nerves responding to a problem in the abdominal cavity. You have a membrane that lines your abdomen called the peritoneum, The nerves here can respond to irritation or cutting. This usually gives you very sharp pain that’s easy to pinpoint. This kind of pain is usually caused by infections in your organs.
Liquids leak out and irritate the lining, causing pain and a condition called peritonitis, There can be several causes for right upper quadrant pain. The most common causes include:
Gallbladder problems Gallstones CholecystitisKidney problemsInfection Kidney stones Urinary tract infectionCancerPancreas problems Pancreatitis PeritonitisStomach problemsPeptic ulcersIndigestion Gastritis Liver problemsInfectionAbscessInflammation
In some cases like indigestion and gastritis, this might cause mild symptoms like burping, gas, bloating, and pain. This can be caused by eating certain foods and may be minor. Other conditions like sudden pancreatitis and peritonitis are serious and might cause sudden and severe symptoms.
The cause of your pain will determine the kind of treatment you get. Your doctor will do different tests to determine the cause. This might include a physical examination where they feel and tap your abdomen. This is called palpating. They will feel your abdomen for masses, if you involuntarily contract your muscles during touch, if the muscles stay tight even when they’re not being touched, or if you flinch with pain.
They will also look for how sensitive you are to touch. If you have these signs, you might have peritonitis. Your doctor might also do other tests, including:
Computed tomography (CT) scanUltrasoundBlood testUrine tests
These tests can help look for inflammation and swelling in your organs. Urine tests will help identify kidney stones or infections. Your doctor will treat you depending on what these tests show. You might receive:
Antibiotics for infectionsAntacids for indigestionSurgery to remove stonesHospitalization for surgery and to receive fluidsPancreatic enzymes for pancreas supportPain relievers
It’s a good idea not to take pain relievers, though, until you figure out what’s causing the problem. Pain relievers can sometimes mask a more serious condition, which could harm your health. Pain in the right upper quadrant can be a sign of a serious health condition. If you have the following symptoms, you should go to the hospital right away:
Severe painFast heartbeatSweatingConfusion Low blood pressure Swelling in your abdomenPain that makes you double overPain that gets worse when you touch your abdomen Throwing up blood Throwing up what looks like coffee grounds
If you don’t have emergency signs but have pain and other symptoms, you should see your doctor as soon as you can.
What is the most common cause of right iliac fossa mass?
Abstract – Background: A mass in the right iliac fossa is one of the commonest problems encountered in surgical practice, requiring skill to diagnose. A clinical diagnosis is often difficult due to other conditions like obesity and guarding, with the mass being palpable only when the patient is on operating table.
Methods: Fifty patients with signs and symptoms of right iliac fossa mass admitted under Osmania General Hospital were identified and were studied by taking detailed clinical history, physical examination and were subjected to various investigations like x ray erect abdomen, chest X-ray, contrast X-ray, ultrasonogram and colonoscopy.
Results: In the present study appendicular mass constituted 46%, appendicular abscess 18%, ileocecal tuberculosis 12%, carcinoma cecum 8%, ovarian tumors 6%, parietal lipoma 4%, and retroperitoneal tumor, parietal abscess and ileocecal tuberculosis all constituting 2% each.
What is a hernia in the right iliac fossa?
Spigelian hernia | Radiology Case Mass lateral to right colon. Axial C+ portal venous phase Right iliac fossa (containgin small bowel and mesenteric fat) within intermuscular space between internal oblique and transverse abdominal muscles, contained by external oblique muscle and fascia superficially, lateral to rectus abdominus. : Spigelian hernia | Radiology Case
Why am I having mild pain on my right side?
Pain on the right side of the abdomen can be caused by conditions such as appendicitis, hernia, kidney issues, reproductive system issues, irritable bowel syndrome (IBS), indigestion, or even gas. There are many possible reasons for discomfort in your right abdominal region.
- More often than not, pain in the lower right abdomen is nothing to worry about.
- It’ll go away on its own in a day or two.
- If you’re experiencing persistent discomfort, though, you should see a doctor.
- They can assess your symptoms and make a diagnosis.
- If you have lower right abdominal pain, you might be wondering if you need to go to the emergency room.
Most of the time, lower right abdominal pain isn’t serious. You should get immediate medical attention if you’re experiencing sudden, severe abdominal pain, or your abdominal pain is accompanied by any of the following symptoms:
a feeling of pressure in your chestpain in your chest, jaw, neck, or armshortness of breath dizziness or lightheadedness difficulty or pain when swallowing sweating feverblood in your vomit or stoolpersistent nausea and vomiting skin or eye whites that appear yellow ( jaundice )severe tenderness when you touch your abdomenunusual swelling of your abdomen black or tar-like stool persistent loss of appetite unusual weight loss
If you notice these symptoms, call 911 or local emergency services or have someone drive you to the nearest emergency room. Treatment can help prevent these symptoms from becoming severe or life threatening.
What is the role of ultrasound in right iliac fossa pain?
Conclusion: Appendicitis was the major cause of the right iliac fossa pain. Abdominal ultrasound was a reliable method in the diagnosis of the majority of patients with right iliac fossa pain and can decrease the rate of negative appendectomy. Keywords: Ultrasound; Abdominal pain; Right iliac fossa; Acute appendicitis.
What organs are in the right iliac region in female?
Right Iliac – The right iliac region contains the appendix, cecum, and the right iliac fossa. It is also commonly referred to as the right inguinal region. Pain in this area is generally associated with appendicitis.
What is migratory right iliac fossa pain?
DISCUSSION – Appendicitis is the commonest surgical emergency, presenting with abdominal pain, in which the classical history of central abdominal pain migrating to the right iliac fossa, is taken for granted. Irvin et al in 1989 performed an audit of diagnoses made on 1190 cases of acute abdominal pain presenting to their surgical department and noted that second to non-specific abdominal pain which comprised 35% of cases, appendicitis was the second commonest at 17% and intestinal obstruction third at 15% ( 1 ).
- Left sided appendicitis has been reported in the literature, with the majority of patients suffering from situs inversus or midgut malrotation.
- One case report noted the incidence of situs inversus to be between 1 in 6000 and 1 in 35000, and midgut malrotation to be even rarer ( 2 ).
- In the absence of either of these abnormalities, there is the possibility of incomplete intestinal rotation, whereby at the end of embryonic intestinal development, the right colonic mesentery is incompletely fixed to the retroperitoneal structures.
It is estimated that in the adult population, sufficient caecal mobility exists in 25% of patients for bascule formation ( 3 ), which was the mechanism of caecal malposition in this case. The classical history of appendicitis is one, which is frequently inconsistent, with patients presenting with a variety of other symptoms that might not point the clinician directly towards the diagnosis of appendicitis.
Indeed, specific scoring tools for suspected appendicitis, such as the MANTRELS score are limited in their diagnostic ability, as 30% of their criteria are by definition, not applicable in patients presenting with an appendix that is not located in the right iliac fossa. The criteria state that whilst abdominal rebound tenderness has a sensitivity of 96% for appendicitis, pain shifting to the right lower quadrant only has an 80% sensitivity with a leukocytosis on white blood cell count also being 80% ( 4 ).
Other studies have shown neutrophilia and a raised C-Reactive Protein to be more sensitive at 95% and 97-100% respectively. It must be noted however that these criteria alone are no substitute for a thorough clinical history and examination. Recently, Helical CT scanning has been advocated as an appropriate, first-line investigation for suspected appendicitis, with a sensitivity of 100%, specificity of 97%, positive predictive value of 97% and a negative predictive value of 100% ( 5 ).
- Imaging, would also enable detection of any rotational, visceral abnormalities.
- Given the increase in availability of Helical CT scanning and its decrease in cost, increased use as evaluation of the acute abdomen should be considered in atypical or diagnostically challenging cases as a minimum.
- Compared to standard CT scanning, Helical CT provides shorter acquisition times, better parenchymal visceral and vascular imaging as well as decreasing the radiation doses involved and quantities of contrast required for accurate imaging ( 6 ).
One of the problems however with CT scanning is attenuation and artefact due to surgical implants for example and care should always be taken to ensure this is considered when contemplating the best imaging modality for the clinical situation. In this case the patient’s Dynamic Hip Screw would have caused severe degradation in the images had the area of interest been in the lower abdomen or pelvis.
The management of appendicitis is not becoming drastically easier with surgeons still performing a number of unnecessary appendicectomies today despite advances in diagnosis and imaging technologies and until a set of robust criteria for diagnosing acute appendicitis, a low clinical incidence of suspicion should be maintained at all times by surgeons when evaluating acute admissions with abdominal pain.
To the authors’ knowledge, this is the first case in English literature, of a case of left-sided abdominal pain and appendicitis, without either of the above anatomical abnormalities. In conclusion, this case highlights the need for vigilance, in all presentations of abdominal pain, with the inclusion of appendicitis as a differential.
What is lymph nodes in iliac fossa?
|Common iliac lymph nodes|
| Common Iliac Lymph Nodes
External Iliac Lymph Nodes
|Regional lymph tissue|
|Source||internal iliac lymph nodes, external iliac lymph nodes|
|Drains to||lateral aortic lymph nodes|
|Latin||nodi lymphoidei iliaci communes|
The common iliac lymph nodes, four to six in number, are grouped behind and on the sides of the common iliac artery, one or two being placed below the bifurcation of the aorta, in front of the fifth lumbar vertebra, They drain chiefly the hypogastric and external iliac glands, and their efferents pass to the lateral aortic glands,
How do you rule out appendicitis?
What happens during appendicitis testing? – Before ordering appendicitis tests, your provider will ask questions about your symptoms and medical history. You’ll also have an exam. If your provider thinks you could have appendicitis, you may have one or more tests to help confirm or rule out the diagnosis.
- Blood tests can help find out if you have an infection or inflammation in your body, but these tests can’t show whether appendicitis is the cause.
- To collect a blood sample, a health care professional will insert a small needle into a vein in your arm to collect a small amount of blood into a test tube or vial.
You may feel a little sting when the needle goes in or out. This usually takes less than five minutes. Urine tests can help rule out a urinary tract conditions that could be causing your symptoms. To collect your urine sample, a health care professional may give you a cleansing wipe, a small container, and instructions for how to use the “clean catch” method.
- CT scan (computed tomography scan). A CT scan is the most accurate imaging test for diagnosing appendicitis. For this test:
- A contrast dye may be used to make your tissues and organs show up better in the pictures. The contrast dye may be given as:
- A drink that you swallow
- An injection into a vein using an intravenous (IV) line
- An enema, which is a tube that injects the contrast medium into your intestine through your anus
- You will lie still on a table that passes slowly through the center of a large donut-shaped x-ray machine. For some scans, the x-ray machine moves around you to take pictures. You may hear whirring sounds from the machine.
- A contrast dye may be used to make your tissues and organs show up better in the pictures. The contrast dye may be given as:
- An ultrasound makes pictures using sound waves. For this test:
- You’ll lie on an exam table and a healthcare professional will put a special gel on your abdomen.
- A handheld wand-like device will be moved across your abdomen and images of your organs will show on a monitor.
- An MRI scan makes pictures using magnets and a computer. For this test:
- You may be given a dye through an intravenous (IV) line.
- You’ll lie very still on a table that slides into an MRI scanner, which is a tunnel-shaped machine. If you have trouble being in closed-in spaces, talk with your provider about options that may make you more comfortable.
- You may be given earplugs or headphones to help block loud sounds from the scanner.
If there’s a chance you could be pregnant, you will likely have a pregnancy test to rule out an ectopic pregnancy, which can cause pain similar to appendicitis. It’s also important to know whether you’re pregnant before having a CT scan. That’s because the x-rays could harm an unborn baby. A pregnancy test may be done with a blood or a urine test.
Can appendicitis pain come and go for months?
Overview Chronic appendicitis is a rare medical condition. It can be difficult to diagnose because the symptoms may come and go, and they can also be mild. The most common symptom is abdominal pain. The likely cause is inflammation or an obstruction in your appendix.
It’s important to get the correct diagnosis because chronic appendicitis can be life-threatening in some cases. Read on to learn more about this condition. The symptoms of chronic appendicitis may be mild. In some cases, abdominal pain is the only symptom with chronic appendicitis. The pain is usually in the lower right side of the abdomen.
It may also appear near the belly button and move to the lower right side of the stomach in some cases. The pain can vary from sharp to dull, but it’s more common for it to be dull. Other symptoms of chronic appendicitis include:
abdominal painfeverabdominal swelling and tendernessfatigue or lethargy, which is a lack of energymalaise, which is a general feeling of discomfort or illness
Some people might also experience nausea or diarrhea. Symptoms may come and go, which can make the condition more difficult to diagnosis. If you have any of these symptoms and they continue to become more severe, consider going to the doctor. They may be a sign of a serious medical problem.
- Chronic appendicitis and acute appendicitis are sometimes confused.
- In some cases, chronic appendicitis isn’t diagnosed until it becomes acute appendicitis.
- Chronic appendicitis can have milder symptoms that last for a long time, and that disappear and reappear.
- It can go undiagnosed for several weeks, months, or years.
Acute appendicitis has more severe symptoms that appear suddenly within 24 to 48 hours, Acute appendicitis requires immediate treatment. The cause of chronic appendicitis is often unknown. Inflammation and obstruction of the appendix are sometimes the cause.
accumulation of fecal mattercalcified fecal depositstumorsenlarged lymphoid follicleswormstraumaaccumulation of foreign objects, like stones, marbles, or pins
When you have an obstruction or inflammation in your appendix, it can allow bacteria to grow and multiply. In chronic appendicitis, the obstruction may be partial. It’s not clear if you can do anything to prevent chronic appendicitis. Eating a diet rich in fiber may lower the risk of appendicitis, but research on diet, nutrition, and eating patterns for the prevention of chronic appendicitis is inconclusive.
- High-fiber foods include whole grains, vegetables, and fruits.
- Your doctor will provide you with a specific treatment plan.
- It’s important to follow all the instructions and take any medication as recommended.
- Sometimes antibiotics are used to treat chronic appendicitis.
- Your doctor may also drain the pus that forms in your appendix.
The most common treatment for chronic appendicitis is an appendectomy, which is surgery to remove the appendix. That can be done using laparoscopic surgery or laparotomy. Laparoscopic surgery has fewer complications and uses smaller incisions. A laparotomy is abdominal surgery through one incision.
acute appendicitisruptured appendixabscess, which is a pocket of infection sepsis, which is your body’s serious response to infection peritonitis, which is inflammation of the abdomen’s lining
It’s important not to ignore your symptoms and to get medical help. The complications of appendicitis can be life-threatening. A ruptured appendix can spread an infection throughout your body. If this isn’t treated immediately, it can be very dangerous.
- Learn more: Emergency signs and symptoms of appendicitis » Chronic appendicitis is different from acute appendicitis.
- The symptoms of chronic appendicitis tend to be milder.
- Abdominal pain is the most common symptom of this condition.
- It’s easy to confuse chronic appendicitis with other medical problems.
However, it’s important to get the right diagnosis. Serious complications can develop from chronic appendicitis if it’s left untreated.
How long can your appendix hurt before it gets bad?
What is appendicitis? – The appendix is a thin tube that is joined to the large intestine. It sits in the lower right part of your belly (abdomen). When you are a young child, your appendix is a working part of your immune system, which helps your body to fight disease.
Can you have mild appendicitis?
Signs of appendicitis you shouldn’t ignore Appendicitis is one of the most common causes of sudden and severe abdominal pain, according to the National Institutes for Health, While most signs of appendicitis do include that telltale sudden and severe pain, it’s important to know that there are other symptoms.
- Appendicitis can sometimes start with mild or moderate symptoms that are easy to confuse with stomach upset,” says, with Riverside Surgical Specialists.
- Nowing how to recognize the signs of appendicitis can help you or a loved one get the immediate care you need.
- After all, appendicitis is a medical emergency,” he finishes.
Dr. Hamdani shares background about appendicitis, including how to recognize it and how it’s treated.
What organs are in the iliac fossa?
Abstract – The main organs in the left iliac fossa are the descending colon, sigmoid colon and, in women, internal reproductive organs. An infection of the left iliac fossa must lead the clinician firstly to suspect diverticulitis of the sigmoid colon in older patients and salpingitis in women of childbearing age.
- Other less common aetiologies are possible (inflammatory or infectious colitis, epiploic appendagitis, abscess of the psoas, pyelonephritis, renal abscess, etc.).
- Sonography as a first-line investigation may lead to diagnosis (especially in gynaecological disease), but a CT scan with intravenous injection of an iodine-containing contrast medium will allow for a full assessment of disease spread, and complications of sigmoid colitis or its differential diagnoses (abscess, fistula, perforation) to be investigated.
It can also be used to guide percutaneous drainage or fine-needle aspiration for microbiology investigations. Copyright © 2012 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.
What causes a mass in the right iliac fossa?
DISCUSSION – The most common disease presenting as right iliac fossa mass was appendicular mass followed by appendicular abscess, Ileocecal koch’s and Carcinoma cecum, in that order. Similar results were obtained in a study conducted by Juniorsundresh et al and Sunil Kumar et al, Appendicular mass In our study, appendicular masses accounted for 46% of cases. All patients came to the hospital for abdominal pain lasting less than one month. Fever was another prominent symptom (74%) and there was vomiting in about 65% of cases. The mean age for appendicular masses was 53.6 years. In the present study, the maximum age incidence was in the 3rd decade (39%), followed by the 4th, 5th and 6th decades. The difference in the mean age in the present study is significant. P value is 0.01. Appendicular masses were more common in males than in females (1.55:1). The sex incidence in the present study is not significant as compared to Jordan et al (2:1). P value is 0.1. Only 2 patients complained of mass per abdomen. But on examination, all cases were found to have a mass in the right iliac fossa. According to Mann, on the third day (rarely sooner) after the commencement of an acute appendicitis, a tender mass can frequently be felt in the right iliac fossa beneath some rigidity of the overlying musculature, with the other quadrants of the abdomen being free from rigidity or tenderness. In the present study, all patients had masses which were tender and firm. According to Skoubo-Kristensen, 55% of his cases experienced febrile episodes with a temperature >39 °C. In the present series, 74% presented with fever and 65% with vomiting. In this study, 62% had hemoglobin values above 10g%. According to Gahukamble, “in situ” delayed appendicectomy seems beneficial for all the patients who respond well to the initial management of appendicular mass. Skoubo say that conservative management of appendicular masses is successful in most cases and complication rates seem lower than with early operative treatment. Appendicular abscesses formed 20% of the present study group. Most of the cases were in the 2nd decade and 77% were females. All patients presented within one month of symptoms. According to Bradley, the mean age at which appendicular abscess occurred was 40.7+/- 2.7. All patients with appendicular abscess in this study group had abdominal pain and fever; 45% presented with vomiting. According to Way et al., when the surgeon encounters an unsuspected abscess during appendicectomy, it is usually best to proceed and remove the appendix. In the present study there were no unsuspected abscesses discovered. According to Bradley, the complication rate was significantly lower and the hospital stay shorter in patients managed expectantly than in those undergoing immediate appendicectomy. Patients who had diffuse peritonitis must undergo immediate appendicectomy, but other patients can be managed with intravenous antibiotics and percutaneous drainage of the abscess if suitable. Ileocecal tuberculosis Elhence said, gastrointestinal tuberculosis, though rare in industrialized countries, continues to be a problem in developing countries. In this study, 12% of masses in the right iliac fossa are due to tuberculosis. Most cases belong to the rural area. According to Prakash, the highest incidence of this disease was found in the age group of 20-40 years. In our study, the maximum age incidence was in the 4th decade (67%). Male to female ratio was 1:1. The difference in age incidence in the present study is not significant. P value is 0.5. The sex incidence in the present study is also not significant. P value is 0.9. In this study, all patients complained of abdominal pain and weight loss, and 50% complained of fever. According to Kelly, a high index of suspicion should be maintained for ileocecal tuberculosis in patients with appropriate clinical features, even if classical risk factors for tuberculosis are absent. According to Prakash, more than 50% of cases had hemoglobin values below 10g% and an ESR >30mm/hour was noted in more than 50% of cases. In the present study, in 70% of cases hemoglobin was less than 10g% and in 83% ESR was >40mm/hour. According to Malik, ultrasound findings in proper clinical settings are diagnostic of tuberculosis. In this study, abdominal ultrasonography was done in all cases. The standard drug regimen used was: first 2 months of 4 drugs (which included Isoniazid, Rifampicin, Pyrazinamide and Ethambutol in the intensive phase), followed by 4 months of continuation phase with 2 drugs, which comprised Isoniazid and Rifampicin. Tuberculosis was confirmed by colonoscopy guided biopsy. Bharati performed a study of the pattern of surgical emergencies of abdominal tuberculosis, and they did right hemicolectomy in 4.5% of cases, limited resection in 6%, and stricturoplasties in 36%. In this study, 50% were managed surgically by right hemicolectomy. All resected specimens were proved histopathologically. Carcinoma cecum In the present study, carcinoma of the cecum formed 8% of cases; all were more than 40 years old. According to Amin, in study of 20 cases, most of the patients were between the age of 45 and 65 years, the oldest patient being 80 years and youngest only 30 years old. In our study, the incidence was higher in males (75%). In the series done by McDermott, 51% were males and 49% were females. According to Goligher, in the majority of cases of cecal carcinoma, constant but not very severe abdominal pain was experienced in right iliac fossa, subcostal region or epigastrium, often associated with local tenderness. Richardson said that sensitivity, specificity and accuracy of abdominal ultrasonography in colonic tumours considered to be consistent with colonic carcinoma were 96%, 67% and 91%, respectively. In the present study, all patients were diagnosed accurately on ultrasonography. Colonoscopy was done and biopsy was taken. According to Goligher’s experience with regard to growths of the cecum and ascending colon, he prefers to practice the more extensive right hemicolectomy except when the patients general condition is such as to compel restriction to the minimum that offers reasonable chance of cure. Ovarian tumours In patients with ovarian mass the predominant symptoms were right iliac fossa mass and loss of weight. The diagnosis was confirmed on ultrasound. Right ovarian cystectomy was done and the specimen sent for histopathological examination. Two of them revealed dysgerminoma. The other cases were parietal lipoma and retroperitoneal tumour for which excisional biopsy was done and the diagnosis was confirmed on histopathological examination; parietal abscess which was drained externally and iliac lymphadenitis which was confirmed on ultrasonography guided FNAC to be of tubercular origin for which anti-tubercular treatment was started. Table 4: Symptoms.
|Diagnosis||No of cases||Fever||Vomiting||Wt loss|
Table 5: Mode of treatment.
|Diagnosis||No of cases||Conservative t/t||Surgical t/t|
|Appendicular mass||23||–||23 (100%)|
|Appendicular abscess||9||–||9 (100%)|
|Carcinoma cecum||4||2 (50%)||2 (50%)|
|Ileocecaltb||6||3 (50%)||3 (50%)|
|Ovarian tumors||3||–||3 (100%)|
|Parietal lipoma||2||–||2 (100%)|
|Retroperitoneal tumor||1||–||1 (100%)|
|Parietal abscess||1||–||1 (100%)|
|Ileocecal lymphadenitis||1||1 (100%)||–|
Table 6: Types of surgical treatment.
|Type of surgery||No of cases||Percentage|
|Oshner Sherren Regime f/b appendectomy||21||42%|
|Extraperitoneal drainage with appendectomy||7||14%|
|Laparotomy and drainage of abscess||4||8%|
|Right ovarian cystectomy||3||6%|
Is the appendix in the right iliac fossa?
Epiploic appendicitis is a common and now well recognized cause of pain in the right iliac fossa (like in the left iliac fossa), with a clinical picture of highly localized pain. However, the septic syndrome is often absent.
Is the kidney in the iliac fossa?
kidney transplant –
In kidney transplant kidney is implanted in the iliac fossa, a space in the groin area just below and to the side of the umbilicus; usually a right kidney is placed in the left fossa and vice versa to aid in making new attachments between blood vessels. The renal artery and vein are