INTRODUCTION:
Right Iliac Fossa Mass is quite commom in our part of country. The mass has varied origin and requires versatility in its management. This is because the mass may range from benign to most aggressively malignant lesion and touch upon various specialities of surgery, like genitourinary surgery, vascular surgery, gynecological surgery, and colorectal surgery.
Hence a detailed study of the variouscauses of Right Iliac Fossa Mass will help in analyzing the different types of presentation and the management. Right Iliac Fossa Mass has 8 anatomical entities, and six other organs in the neighbourhood whose pathology may extend into this region. Right Iliac Fossa region has Appendix, Cecum, Terminal Ileum, Lymphnodes, Iliac artery and vein, Retroperitoneal connective tissues, Iliopsoas muscle, and Iliac bone. Neighbouring organs and their pathologies which might extend into this region are Kidney, Gallbladder, Uterus, Urinary Bladder, Testis, and Pelvic abcess. Hence, this study has been initiated with a view to analyse:
1. Incidence of different types of Right iliac fossa masses.
2. Variable clinical presentstion and investications most helpful for each case.
AIMS OF THE STUDY:
1. To evaluate
a) The incidence of various causes of Right iliac fossa masses and the commonest
causes.
b) Various modes of presentations of Right iliac fossa masses.
c) Most helpful investigations for aiding in diagnosis of Right iliac fossa masses.
2. To determine the management of right fossa masses whether by emergency surgery or by conservative measures.
MATERIALS AND METHODS:
Over a period of time from 2004 to 2006 all the patients admitted in the surgical wards
were examined and patients who had a lump in the right iliac fossa were grouped for the
study. In this study total of fifty patients were taken up for study over the previous two and half years duration. pediatric cases were not included in this study group.
Routine thorough history was elicited, and detailed clinical examination was performed. Routine hematological and biochemical investigations were done. Radiological examinations, X-rays chest PA view was taken to all patients, along with X-ray abdomen plain view for correlation and contribution to the diagnosis.
Specific investigations were also performed, considering the merits of the individual case. USG β abdomen was performed for all cases. Depending on the requirement of individual case presentation Barium meal series or Barium Enema evaluation was performed. Colonoscopy was not done as this facility was not available at this centre. CT Scan abdomen contrast study also done.
CONCLUSION:
1. Appendicular mass is the commonest of all right iliac fossa masses, 46%, followed by ileocecal TB,Ca.cecum, ovarian cyst. The frequency of unusual cases is difficult to assess in a small study like this.
2. In younger age group, inflammatory masses like appendicular mass, iliocecal TB predominate and ovary mass in young females is an important cause of right iliac fossa mass. Ca.cecum and appendicular abscess are more common in the older age group.
3. USG abdomen as a preliminary investigation in the right iliac fossa masses has been found to be useful in deciding further investigations and planning management.
4. Appendicular mass presents with short duration of pain. In about 20% of patients consevative treatment has to be abondened in favour of surgical intervention.
5. Ileocecal TB is more common in males in this small study. Barium enema is the investigation of choice for patients with chronic symtoms. about 45% of cases of ileocecal TB presented acutely and needed emergency laparatomy for diagnosis and treatment.
6. Ca.Cecum fecal occult blood loss and weight loss are almost and always present.
7. A complicated ovarian cyst should be always thought of in young females, with acute abdominal pain and right iliac fossa mass
