Right Iliac Fossa Mass: Case Presentation by K. Umashankar and G. Praveen

RIGHT ILIAC FOSSA MASS
Case Presentation by
K. Umashankar and G. Praveen
DEMOGRAPHIC DETAILS
 Mr. Kumaravel,
 60 years old male,
 farmer,
 coming from Ponneri,
 belonging to lower middle class.

CHIEF COMPLAINTS
 Pain in the right lower abdomen for past 2 month.
 Swelling in the right lower abdomen for past 1 month.
HISTORY OF PRESENTING ILLNESS
 Patient was apparently normal 2 month back , After
which developed Pain in the lower abdomen on right
side for past 2 month insidious in onset, dull aching pain,
on and off, no aggravating or relieving factors, not
radiating.
 H/O swelling in the lower abdomen on right side for past
1 month insidious in onset, gradually progressed to the
present size, associated with pain.
 H/O Fever for past 1 month, low grade, intermittent,
evening rise of temperature, not associated with chills
and rigors.
 H/O Cough with expectoration for past 1 month
 H/O loss of weight
 H/O loss of appetite
 H/O diarrhoea altered with constipation
 No H/O vomiting
 No H/O abdominal distension
 No H/O bleeding per rectum, blood in stools
 No H/O painful, increased frequency of urination,

hematuria
 No H/O jaundice, bone pain
PAST HISTORY
 H/O Tuberculosis- 35 years back treated with anti
tubercular drugs(completed 6 months).
 No H/O Diabetes mellitus, Hypertension, Bronchial
asthma, Epilepsy.
 No H/O Blood tansfusion
PERSONAL HISTORY
 Mixed diet
 Normal sleep pattern
 Loss of appetite
 Normal bladder habits
 Altered bowel habits
 H/O smoking for past 30 years, 4 beedis per day

smoking index- 120
 H/O consume alcohol for 20 years, 180ml of brandy per
day, stopped before 10 years
 No H/O betel nut chewing
 ALLERGIC HISTORY:
No H/O allergy to drugs or food.
 FAMILY HISTORY:
No significant family history
SUMMARY
 Mr.Kumaravel, 60 years old male, farmer coming from
ponneri came to OP with complaint of pain in the right
lower abdomen for 2 months, insidious in onset, dull
aching pain, on and off.
Swelling in the right side of lower abdomen for 1 month,
insidious in onset, gradually progressed to the present
size, associated with pain. Fever for 1 month, low grade,
intermittenr, evening rise of temperature. Cough with
expectoration for 1month. Loss of weight and loss of
appetite. Diarrhoea altered with constipation. Known
case of tuberculosis for 35 years ,on completed 6 month
medication. Smoking for 30 years, consume alcohol for
20 years, stopped before 10 years.
GENERAL EXAMINATION
 Patient is conscious, oriented to time, place, person
 Thin built and poorly nourished
 Pallor present, clubbing present – grade 2
 No icterus, cyanosis, pedal edema, generalized

lymphadenopathy.
VITALS
 Pulse rate:
86 beats/min, regular in rhythm, normal in volume, no
specific character, condition of vessel wall normal, no
radio-radial or radio-femoral delay, felt in all palpable
peripheral vessels.
 Blood pressure:
110/70 mm Hg, in right upper arm in sitting posture.
 Respiratory rate: 16 breaths/min , Abdomino-thoracic
breathing
 Temperature: 98.6°F
ABDOMEN EXAMINATION
INSPECTION
 Abdomen- scaphoid shape
 Umbilicus in midline and inverted
 All quadrants move equally with respiration
 No scar,sinus, dilated vein, visible pulsation
 No fullness, visible peristalsis
 Flank free, hernial orifices free, external genital normal

PALPATION
 Patient in supine position with hip flexed
 No warm, No tenderness
 A mass is felt in the lumbar region of size 5×4cm, oval in shape
 Extends-medially 7cm from umbilicus
Laterally 8cm from anterior superior iliacspine
Superior 4cm from right costal margin at midclavicular line
Inferiorly 5cm from pubic symphsis
 Firm in consistency, with smooth surface, with well defined margins
 Freely mobile in all directions
 Leg rising test (carnett’s test)-mass does not become prominent-intra
abdominal mass
 Knee elbow test- mass falls forward
 No guarding, rigidity
 No other mass palpable
 No organomegaly
 Mass is not ballotable
 PERCUSSION:
Impaired resonance over the mass
liver span- normal
 AUSCULTATION:
Normal bowel sounds heard
 OTHER SYSTEM EXAMINATION:

CVS: S1,S2 heard, no murmur
RS: Normal vesicular breath sound heard
CNS: No focal neurological deficit
PROVISIONAL DIAGNOSIS
 A case of Right iliac fossa mass probably Ileocecal
tuberculosis.
DIFFERENTIAL DIAGNOSIS:
 Ileocecal tuberculosis
 Carcinoma caecum
INVESTIGATION
 Routine:
CBC, Hemoglobin, ESR, Blood grouping and typing.
Blood sugar, urea, serum creatinine, electrolytes.
Urine – albumin, sugar, deposits.
Stool-occult blood.
X-ray chest, ECG.
 Specific:
USG abdomen, Barium swallow test, X-ray abdomen,
CT abdomen
Mantoux, Sputum for acid fast bacilli, BACTEC
CEA,Alpha fetoprotein(tumor markers)
Colonoscopy.
BARIUM STUDY
 Pulled up caecum
 Narrowed terminal ileum
 Widening of ileo-caceal
angle
TREATMENT
 ILEOCECAL TUBERCULOSIS:
Anti Tubercular drugs:

2HRZE + 4HR (6 months)
Ileocecal resection
 CARCINOMA CAECUM:
Right hemicolectomy

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RIGHT ILIAC FOSSA MASS

 coming from Ponneri,

 belonging to lower middle class.

 H/O diarrhoea altered with constipation

 No H/O abdominal distension

 No H/O bleeding per rectum, blood in stools

 No H/O painful, increased frequency of urination,

 Normal bladder habits

 Altered bowel habits

 H/O smoking for past 30 years, 4 beedis per day

 Pallor present, clubbing present – grade 2

 No icterus, cyanosis, pedal edema, generalized

 All quadrants move equally with respiration

 No scar,sinus, dilated vein, visible pulsation

 No fullness, visible peristalsis

 Flank free, hernial orifices free, external genital normal

 OTHER SYSTEM EXAMINATION:

Anti Tubercular drugs:

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