RIGHT ILIAC FOSSA
MASS
TAMILSELVI C
FINAL YEAR MBBS
Thirumalai
13 year old boy
studying 7th std
coming from Ponneri,
belonging to socio economic class IV
came to the OP
CHIEF COMPLAINTS
Pain in the right lower abdomen for
past 4 days
PRESENTING ILLNESS
The patient was apparently normal 4 days back
after which he developed
pain : in right lower abdomen
for 4 days,acute in onset
colicky in character
intermittent in nature with symptomless
interval,started in the umbilical region and
progressed towards right iliac fossa
moderate to severe intensity
aggravated by coughing and relieved
by rest.
H/O Vomiting: for 3 days
3-4 episodes/day-immediately
after eating
contains food particles
non projectile,not bile
stained,not blood stained,not foul smelling
relieved by antiemetics
H/O FEVER: for past 3 days,
sudden in onset,
low grade fever,continuous,
not associated with chills and
rigors,
no h/o evening rise of temperature,
not associated with night
sweats,convulsions,altered sensorium,
relieved by medication.
He is currently afebrile
H/O loss of appetite for past 3 days
No H/O cough with expectoration
No H/O Loss of weight
No H/O Abdominal distension
No H/O Constipation, Diarrhoea
No H/O Bleeding per rectum, blood in stools
No H/O Painful, increased frequency of
urination, hematuria
No H/O Jaundice, bone pain
No H/O headache,blurring of vision
PAST HISTORY
No H/O similar complaints in the past
No H/O Diabetes mellitus, Hypertension,
Bronchial asthma, Epilepsy,jaundice
NO H/O previous surgery and hospitalisation
No H/O Blood transfusion
PERSONAL HISTORY
Consumes non vegetarian diet
Non smoker,not an alcoholic
Normal bowel and bladder habits
ALLERGIC HISTORY:
No H/O Allergy to drugs or
food.
FAMILY HISTORY:
No significant family history
GENERAL EXAMINATION
Patient is conscious, oriented,
Moderately built and nourished
No Pallor
No icterus
No cyanosis
No Clubbing
No pedal edema
No generalized lymphadenopathy
Hydration:fair
Afebrile
VITALS
Pulse rate: 86/min, regular in rhythm,
normal in volume, no specific character,
no radio-radial or radio-femoral delay,
felt in all palpable peripheral vessels
Respiratory rate: 18/min,abdomino
thoracic
Blood pressure: 110/70 mm Hg, in right
upper arm in sitting posture
LOCAL EXAMINATION OF
ABDOMEN
After getting consent from patient and
explaining procedure to patient,he is
exposed from nipples to mid thigh,and
examined on both sides under bright light in
supine position with male attender by the
side.
ABDOMEN EXAMINATION
INSPECTION:
Abdomen – Normal in shape, umbilicus in
midline and inverted
All quadrants move equally with respiration
No scar, sinus, dilated veins, visible pulsation
No fullness, visible gastric/intestinal peristalsis
Flanks free, hernial orifices free, external genitalia
normal
Renal angle free
Left supraclavicular fossa- normal
PALPATION
Patient in supine position with hips and knees
semi flexed
Not warm, tenderness at McBurney’s point,
guarding present
A mass is felt in the right iliac fossa of size 3*3 cm,
hemispherical in shape
Extends-medially 2cm from umbilicus
laterally 3cm from anterior superior
iliac spine
superiorly 5cm from right costal margin
at midclavicular line
inferiorly 4cm from pubic symphysis
Firm in consistency, with irregular surface,with ill
defined borders,immobile,no pulsation,normal skin
No organomegaly
Left supraclavicular region -no nodes
palpable
Hernial orifices- free
External genitalia-normal
Carnett’s test-negative
Renal angle –no tenderness
Per rectal examination to be done
PERCUSSION:
Impaired resonance over the
mass
other quadrants-tympanic
resonance
Liver span – normal
AUSCULTATION:
Normal bowel sounds heard
OTHER SYSTEM EXAMINATION
CVS- S1, S2 heard, no murmur
RS- Normal vesicular breath sounds heard
CNS- No focal neurological deficit
SPINE and CRANIUM-normal
DIAGNOSIS
A case of Right iliac fossa mass probably
Appendicular mass.
INVESTIGATIONS
Baseline :
Blood inv- Hemoglobin, Total count,
Differential count, ESR, Blood grouping and
typing
Blood sugar, Urea, Serum creatinine,
Electrolytes
Urine- albumin, sugar, deposits
Stool- occult blood
Xray Chest, ECG
SPECIFIC INVESTIGATIONS
Ultrasound abdomen
Xray abdomen erect
CT scan abdomen
Mantoux, Sputum for acid fast bacilli
Tumour markers- CEA, Alpha fetoprotein
Colonoscopy
TREATMENT
APPENDICULAR MASS:
1. Ochsner and Sherren regimen
A-aspiration with ryles tube
B-bowel care(do not give purgatives)
C-charts
D-drugs
E-exploratory laparotomy not to be done
F-fluids(nil oral for few days)
[Link] appendicectomy after 6 weeks
Thank you
