English

Abstract

INTRODUCTION: Right iliac fossa mass may arise from parietal wall or intraperitoneum or retroperitoneum. Mass may arise from right iliac regional structures or extended from adjacent structures. Appendicular pathology is commonest cause for right iliac fossa mass (either appendicular mass or abscess). Other common causes are ileo-caecal tuberculosis and carcinoma caecum. Appendicular mass is formed by inflamed appendix adherent with dilated ileum, greater omentum and caecum. Appendicular abscess due to suppuration in an acute appendicitis or suppuration in an already formed appendicular mass. Abdominal tuberculosis is common in developing countries like India. It is sixth most common type of extra pulmonary tuberculosis. Its incidence is high in HIV infected patients. Ileo-caecal tuberculosis is commonest type of abdominal tuberculosis due to presence of Peyer's patches and stasis of luminal contents favoured by ileo-caecal valve. Commonest type of carcinoma in caecum is adenocarcinoma. Third common site in large bowel carcinoma (12%). Diet with lack of fibres and high fat increases risk. Dietary vitamins A, C, E (antioxidants) and Zinc and high fibre diet reduce the risk. Diagnosis of right iliac fossa mass mainly depends on complete clinical examination, radiological, biochemical, microbiological and pathological investigations. Commonest cause of right iliac fossa mass in our country is appendicular mass or abscess, ileo-caecal tuberculosis and carcinoma caecum. OBJECTIVES: To study the aetiology, pattern of presentation, management and complications in patients with right iliac fossa mass in our institution. MATERIALS AND METHODS: This retrospective study was carried out in our institution over a period of two years from October 2010 to October 2012. All patients who are provisionally diagnosed to have mass in the right iliac fossa by clinical evaluation are included in the study. All data including age, gender, relevant history, investigations (complete blood count, Blood grouping and Rh typing, HIV I & II, Chest radiograph, Ultrasound abdomen and pelvis, CT Scan abdomen and pelvis, IVP and barium follow through and enema, FNAC, BIOPSY) were done to conclude the final diagnosis and appropriate treatment and postoperative complications and final histopathological reports were recorded in the standard forms. Cases are selected by following Inclusion and exclusion criteria; Inclusion criteria: All the cases admitted with Right iliac fossa mass in our institution. Exclusion criteria: Female patients with gynaecological diseases. Paediatric age group (<12 years) patients with right iliac fossa mass. CONCLUSION: Right iliac fossa mass was common in 20 to 50 years of age group. Overall incidence was more common in males as compared to females (1.1:1).Appendicular pathology and Carcinoma caecum was more common in males as compared to females. Ileo-caecal tuberculosis was more common in females. The diseases were more in people from low socio –economic status and the commonest symptom was pain in abdomen. Appendicular pathology (60%) either in the form of appendicular mass (32.5%) or appendicular abscess (27.5%) were the commonest cause of mass in the right iliac fossa. Ileo-caecal tuberculosis (20%), carcinoma caecum (12.5%) was the other common causes of mass in the right iliac fossa. Ultrasound abdomen was the essential investigation and it had a sensitivity of greater than 95%. Normal levels of serum CRP titer essentially ruled out appendicular pathology. Serial titers were helpful in assessing the treatment response of ileo-caecal tuberculosis and in prognosis of carcinoma caecum. In patients with appendicular mass, initial conservative management followed by interval appendicectomy had better results with minimal complications. In patients with appendicular abscess, abscess drainage combined with appendicectomy in the same procedure, had high morbidity compared to patients who underwent interval appendicectomy following abscess drainage. 44% of the patients with ileo-caecal tuberculosis were managed conservatively with anti-tubercular therapy (DOTS-I). Surgery was required in another 56 % of the patients, of which 25 % of the patients presented with acute complications needing immediate surgery. 31 % of the patients presented with sub-acute intestinal obstruction due to adhesions and strictures following the initiation of anti-tubercular therapy, which later required surgical intervention. 80 % of the patients with carcinoma caecum underwent successful surgical resection. 20 % of the patients presented with acute surgical problem requiring immediate surgery. 10 % of the patients presented with advanced disease. Most of the parietal wall and retroperitoneal conditions were treated surgically. Early evaluation and intervention is needed to improve the patients’ outcome and to reduce the morbidity and mortality.