Iliac Fossa Mass Research Articles

Appendicular schwannoma: Case report of a rare differential of a right iliac fossa mass

Schwannomas are slow growing, mostly benign tumors arising from the Schwann cells of the nerve sheath. They usually arise from the nerves of the head-and-neck region. They are rare in the gastrointestinal tract. The stomach is the most common site for gastrointestinal schwannomas. Appendicular schwannomas are even a rarer entity that may present as a right iliac fossa mass. The final diagnosis is by histopathology and immunohistochemistry. Treatment is essentially surgical. Such entities may present as diagnostic dilemmas presenting as the not-so-common cause of iliac fossa mass and hence deserve reporting and discussion. We report our experience of treating a case of appendicular schwannoma in a 70-year-old lady with a short discussion on its characteristics and management.

Late Onset of Renal Abscess Mimicking Malignancy in a Retransplant Female

Abstract A 67-year-old female, a retransplanted kidney recipient from her daughter in 2012 on triple immunosuppressants with chronic kidney disease Stage IIIb, presented with fever, loss of appetite, right iliac fossa pain, and tiredness for 2 weeks. Her first kidney transplant was done in 1998 with external iliac vessels being used for the anastomosis. She is a diabetic, hypertensive, hypothyroid, and post-COVID status who had previously recurrent urinary tract infections since 2022. She was found to have a right iliac fossa mass at the site of the first kidney transplant, which was tender. Imaging including ultrasound and positron emission tomography/computed tomography showed a metabolically active right iliac fossa mass infiltrating the anterior abdominal wall. Surgery revealed a mass and on histopathology revealed a renal abscess which grew Candida ciferrii and tissue culture grew Enterobacter cloacae. She was treated with injection levofloxacin and tablet posaconazole and she recovered. This patient was presented for the interesting finding of coinfection in the late posttransplant period.

Clinico-patho-radiological study of mass in the right iliac fossa

Abstract Background: Sparse recent data are available regarding the aetiological causes of the right iliac fossa (RIF) mass from Andhra Pradesh. Methods: We prospectively studied the clinical presentation, diagnosis and management of consecutive cases (n = 100) presenting to our tertiary care teaching hospital with a RIF mass over 2 years. Results: Majority of RIF masses were seen in the third and fourth decades of life, and the male-to-female ratio was 2.8:1; 64% of the cases were due to appendicular pathology (appendicular mass [48%] and appendicular abscess [16%]), followed by ileocaecal tuberculosis (TB) (12%) and carcinoma caecum (10%) among others. Carcinoma caecum was more common in males (70%) as compared to females (30%). The majority (78%) were managed surgically; 4% died. Post-operative complications included wound infection and respiratory tract infection. Conclusions: Our observations suggest that appendicular pathology, ileocaecal TB and carcinoma caecum are common aetiological causes for RIF mass. Abdominal ultrasonography and computed tomography will facilitate early localisation.

Chronic sigmoid diverticulitis causing tubo-ovarian abscess and colo-uterine fistula

Abstract Colo-uterine fistulas are rarely reported in the literature, and its presentation in the presence of a tubo-ovarian abscess secondary to chronic sigmoid diverticulitis is currently not reported. As such, its presentation may pose a diagnostic dilemma. Here, we present a 68-year-old woman who was admitted under the colorectal service with a 1 month history of mild left iliac fossa pain, with computed tomography (CT) demonstrating complicated sigmoid diverticulitis. Progress CTs, however, demonstrated a progressively enlarging left iliac fossa mass, with air fluid levels, densely adherent to the sigmoid colon. The decision was eventually made to perform a laparoscopy, which demonstrated a left tubo-ovarian abscess communicating with the uterus and sigmoid colon, illustrating a colo-uterine fistula. Open resection of the sigmoid colon and uterus was performed and the patient recovered uneventfully. This case describes an uncommon complication of chronic sigmoid diverticulitis and the importance of its judicious surgical management.

COMPARISON OF RIPASA AND ALVARADO SCORING SYSTEM IN DIAGNOSIS OF ACUTE APPENDICITIS IN TERTIARY CARE

Introduction: Acute appendicitis is one of the most common surgical emergencies, with a lifetime prevalence rate of approximately one in seven. Different techniques have been devised to assist in equivocal cases in attempts to decrease negative appendectomy rates. RIPASA and ALVARADO scores are new diagnostic scoring systems for diagnosis of acute appendicitis . RIPASA scoring system has more sensitivity, specificity and diagnostic accuracy than ALVARADO score in diagnosis of acute appendicitis in Asian population. Hence this study conducted to compare RIPASA AND ALVARADO score in diagnosis of acute appendicitis in tertiary care hospital. RIPASA score includes more parameters than ALVARADO score such as age, gender, duration of symptoms prior to presentation Aims and objectives: To compare RIPASA and Alvarado score in diagnosing acute appendicitis using histopathology as gold standard Materials and Methods: Source of Data: Basaveshwar teaching and general hospital from august 1st to 30th september 2022 Study Design: Prospective observational study. Study Population: 74 patients Inclusion criteria All patients who presented with right lower quadrant abdomen pain and diagnosed as acute appendicitis. Exclusion Criteria: Patients under 18 years of age. Patients with right iliac fossa mass. Patients with features of peritonitis All these patients were scored as per RIPASA and Alvarado scoring system after taking history , clinical examination and laboratory investigations. RIPASA includes 18 parameters and Alvarado 8 parameters. A score of 7.5 taken as high probability of acute appendicitis as per RIPASA and score of 7 for Alvarado scoring system. The decision of appendicectomy solely based on surgeonÂ’s own clinical judgement After the surgery, histopathological reports of operated cases correlated with scoring systems.

Colonic medullary carcinoma: an exceedingly rare type of colorectal malignancy: a case report and review of the literature

BackgroundMedullary carcinoma of the colon is a rare subtype of colorectal cancer that has a unique, and sometimes varied, clinical and histologic profile. It usually presents in adult patients older than 50 years. Here, we report a unique case of young male patient who initially presented with abdominal pain followed by a large bowel obstruction.Case presentationA 40-year-old SriLankan male presented with right-sided abdominal pain and on examination, there was a palpable right iliac fossa mass. Colonoscopy and a computed tomography scan revealed cecal mass. Later, while waiting for elective resection, the patient developed symptoms and signs of a large bowel obstruction. He underwent a laparoscopic right hemicolectomy with an uneventful postoperative course. The histopathologic evaluation of the resected specimens showed invasive carcinoma with syncytial growth pattern, foci of lymphoid host response, and dirty necrosis, in keeping with a medullary carcinoma pT4a pN2b. Unlike most reported medullary carcinoma cases, this patient was young and caudal-related homeobox transcription factor 2 positive.ConclusionWe have reported another case of medullary carcinoma of the colon in a young patient with unique histologic characteristics. Reporting such cases helps in refine understanding of the histologic and genetic, as well as clinical, phenotypes of medullary carcinoma of the colon.

DIFFERENTIAL DIAGNOSIS OF RIGHT ILIAC FOSSA MASS AND THEIR MANAGEMENT

Background: Right iliac fossa mass is a common clinical entity encountered in routine surgical practice. The mass arises from different anatomical structures with varied aetiologies that require a high clinical suspicion in its management. The reason being that the mass may range from being benign to most aggressively malignant lesion which encompasses various specialities of surgery like genitourinary, vascular, gynaecological and colorectal surgery. This was a prospective observational study conducted betw Methods: een October 2021 and September 2022 in Silchar Medical College and Hospital, Silchar, Assam. 45 cases were studied after detailed history and physical examination, relevant investigations were done, and different surgical procedures done were noted and histopathological examination of resected specimens was done. In this series Results: out of 45 patients studied, 35 patients (77.5%) were diagnosed to have appendicular mass, 05 cases (11%) appendicular abscess, 02 cases (4.5%) ileocaecal TB, 02 cases (4.5%) psoas abscess, 01 cases (2.5%) Ca Caecum. Most commonly encountered in 3rd decade followed by 4th decade of life with male predominance. RIF mass is a challenging clinical sce Conclusions: nario for the surgeons. Keeping in mind the various differential diagnosis with good clinical acumen supported by appropriate investigations, patients with RIF mass can be managed appropriately either by conservative or surgical management.

A RIGHT ILIAC FOSSA MASS - A PERFORATED ILEAL GASTRO-INTESTINAL STROMAL-TUMOUR

GASTRO-INTESTINAL STROMAL-TUMOURs (GASTRO-INTESTINAL STROMAL-TUMOURs) are tumours of the gut found mostly in stomach and small intestine. The complications are Gastrointestinal (GI) bleeding, obstruction, pain and rarely perforation. We are reporting an abnormal presentation of GASTRO-INTESTINAL STROMAL-TUMOURS presenting as an acute abdomen pain with Right Iliac Fossa (RIF) mass in 57-year-old male. Contrast Enhanced Computed Tomography (CECT) of abdomen revealed a peripherally enhancing encapsulated abscess in RIF close to the base of caecum and surrounding peritonitis suggesting a caecal perforation. On laparotomy, a perforated ileal GASTRO-INTESTINAL STROMAL-TUMOURS was identified. Pathological examination confirmed the tumour to be a GASTRO-INTESTINAL STROMAL-TUMOUR of spindle cell type, further reiterated by immunohistochemistry. Our case report emphasizes, GASTRO-INTESTINAL STROMAL-TUMOUR are a rare differential diagnosis of RIF mass, and to have high clinical suspicion when a similar case is encountered in an emergency room, keeping in mind the poor outcome caused by delay in appropriate management of the disease.

A TROJAN HORSE NEVER TO BE MISSED IN ELDERLY – AN INTRESTING CASE OF RIGHT ILIAC FOSSA MASS

We report a case of an elderly patient presenting with the right iliac fossa mass. The provisional diagnosis included an inammatory appendicular mass or abdominal wall mass. Interestingly, initial non-contrast computed tomography (CT) of the abdomen and pelvis, lap parameters and colonoscopy guided biopsy demonstrated the inammatory changes. Follow up imaging by contrast CT threw light on a new path towards the neoplastic etiology. Even after the follow up imaging the subsequent colonoscopy guided biopsy showed features suspicious for malignancy whereas cystoscopy guided biopsy showed benign features. Intra-operatively bowel neoplasm with bladder invasion was seen and right hemicolectomy with partial cystectomy done. Post-operative specimen nally revealed mucinous adenocarcinoma of caecum with urinary the bladder invasion. In the presented case, non-contrast CT ndings and clinico-pathological reports suggestive of a benign etiology were misleading. This could have been prevented if the patient was subjected to contrast study in view of her elderly age. This case highlights the importance of imaging in patient management. Therefore, we feel that it is important to share our experience of the successful management of the presented case.

Retrospective Analysis of Right Iliac Fossa Mass: A Single-Center Study.

BackgroundRight 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.MethodsA 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.ResultsIn 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.

A Clinico - Ultrasonological Study on Preoperative Evaluation of Right Iliac Fossa Mass

BACKGROUND
 Right iliac fossa mass, a common condition, needs accurate arrival of diagnosis since management of each condition differs. Ultrasound is a quick, non-invasive test that has bridged the gap between palpation and direct visualization. The role of ultrasound in preoperative evaluation proves to be essential as it enables the surgeon to diagnose and treat the pathology with accuracy thereby obviating the need for further investigations. We wanted to evaluate the role of ultrasound in preoperative evaluation of right iliac fossa mass.
 METHODS
 A prospective study of 60 patients with clinically diagnosed RIF mass was done. Ultrasound examination by 5 and 7.5 MHz transducers was done and the clinical, radiological findings and final diagnosis were compared.
 RESULTS
 In our study, vast majority of the cases (50 %) presented with appendicular mass, 24 % presented with appendicular abscess, ileocaecal tuberculosis 17 %, carcinoma caecum 7%, psoas abscess 1 % and ileal lymphadenopathy 1 %. The appendicular abscess was common in 15-20 years, appendicular mass in 21-40 years, ileocaecal tuberculosis in 41-50 years, carcinoma caecum was in > 50 years, psoas abscess in 21-30 years, and ileal lymphadenopathy in 20-34 years of age. Ultrasound was able to find out the bowel thickening with target sign and pseudo kidney sign in ileo-caecal tuberculosis and carcinoma caecum with moderate specificity. Psoas abscesses were confirmed with ultrasound.
 CONCLUSIONS
 Appendicular pathology constituted a majority of cases. The ultrasound was able to detect appendicular abscesses with high sensitivity and specificity. It is an adjuvant diagnostic tool in cases of ileocaecal tuberculosis and carcinoma caecum. Ultrasound helped in the early assessment of the patient, enhanced the treatment effectiveness thereby reducing the morbidity and enabled early surgical intervention whenever necessary. Ultrasound, a non-invasive radiological imaging without any exposure to radiation with excellent results is an ideal first-line imaging modality in the preoperative evaluation of RIF mass.

Clinical Study of Pain in Right Iliac Fossa

Background: To study the clinical profile of pain in right iliac fossa.
 Methods: 100 patients with signs and symptoms of right iliac fossa mass admitted in 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 .
 Result: In this study of out of 100 cases, 71.00% of cases were related to appendicular pathology either in the form of appendicular mass or appendicular abscess. There were 9.00% cases of Ileocaecal tuberculosis.
 Conclusion: Appendicular lump remains the most common cause for right iliac fossa pain. Ileocaecal tuberculosis is one of the most important differential diagnoses for pain abdomen.
 Keywords: Appendicitis, , Right Iliac Fossa Mass, Pain

Diagnosis of Coxiella burnetii infection via metagenomic next-generation sequencing: a case report

BackgroundCoxiella burnetii, the etiologic agent of Q fever, is mainly responsible for endocardite. But there are only a few cases of Coxiella burnetii-caused wound infection have been published, because the pathogen is very difficult to isolate using conventional culture methods.Case presentationsA 76-year-old man, underwent endovascular repair of ruptured left iliac aneurysm plus abdominal aortic aneurysm under general anesthesia in 2018. Left iliac fossa mass resection was performed in 2020. After operation, the wound in the left iliac fossa was repeatedly ruptured and not healing. We used the wound tissue to perform the Metagenomics next-generation sequencing (mNGS), Coxiella burnetii was detected. Sanger sequencing and serologic verification of Coxiella burnetii all showed positive results.ConclusionsThis study proved that mNGS was an effective method to detect clinically unexplained infections, and showed the ability of pathogen identification with high sensitivity and accuracy.

Double-Expressor Appendiceal Burkitt’s Lymphoma: A Case Report and Literature Review

Background Appendiceal lymphoma is a very rare entity accounting for 0.015% of all gastrointestinal lymphoma cases. Acute appendicitis is the most common presentation of primary appendix neoplasms. Burkitt's lymphoma presenting as an acute appendicitis is a rare entity with around 21% of the cases presenting as a lower iliac fossa mass. Case Presentation. A 23-year-old male was admitted to the surgical ward as a case of acute appendicitis with localized tenderness in the right iliac fossa, positive rebound tenderness, a positive Rovsing's sign, and ultrasound findings of suspected complicated appendicitis. Appendectomy was performed. Histopathological examination of the appendectomy specimen revealed a double-expressor non-Hodgkin diffuse large cell lymphoma with Burkitt's-like morphology. He was sent for chemotherapy treatment. Conclusion Only 34 cases of Burkitt's lymphoma have been reported to present as acute appendicitis. Histological examination following appendectomy for an apparent appendicitis is essential. Furthermore, complete blood count and a computed tomography scan aid the diagnosis of lymphoma. Double-expressor lymphoma has been shown to have poor outcomes. Therefore, prompt and aggressive treatment is vital.

PRIMARY LYMPHOMA OF THE COLON – A MASQUERADER OF RIGHT ILIAC FOSSA MASS

Primary lymphoma of the colon ,a not so surgical entity at times can be one of the differential diagnosis of the Right Iliac Fossa mass. Lymphoma of the gastrointestinal tract are more commonly seen in stomach , small intestine followed by large intestine . Among large intestine it is more commonly seen in caecum followed by rectum and ascending colon . The clinical significance lies in the rarity of these conditions and mimicking a adenocarcinoma colon. So high index of suspicion is required in diagnosing these conditions preoperatively and guiding in the right path of management . Lymphoma can be of their B cell or T cell origin . B cell lineage are the most commonly occuring entity accounting for 90% ;of which Diffuse Large B cell Lymphoma and MALToma are most common .Hereby presenting a case of 74 year old female who presented with Right iliac fossa mass and loss of weight posing a diagnostic challenge preoperatively and turned out to be a Primary Lymphoma of the colon in Post op Histopathology

Clinical Study of Right Iliac Fossa Mass: A Prospective Study

A right iliac fossa mass is a ‘temple of surprises’ and a common presentation at emergency department, requiring skill and keeness to diagnose. Patients with right iliac fossa mass will be dealt by a general practitioner, a surgeon or a gynecologist and knowledge of anatomy, with detailed history, clinical examination directing towards the pathological process followed by lab analysis and imaging leads to a diagnosis. The most common differential diagnosis encountered are: appendicular mass, appendicular abscess, ileocecal tuberculosis, right ovarian mass, right ectopic kidney, rectus sheath hematoma, carcinoma caecum and ameboma, actinomycosis and crohn’s disease. An important differential diagnosis is often between an appendicular mass, carcinoma of the caecum and ileocecal tuberculosis.3 In Subcontinent, tuberculosis has been the main cause of intestinal obstruction and perforation. Cecal carcinoma is more common in the elderly and higher socio-economic group consuming less brous diet.1,5,6 Appendicular masses are seen in relatively younger people with both conservative and operative strategies. Other less common causes are diagnosed and managed accordingly.7

Amoebic liver abscess with right iliac fossa lump- an atypical presentation

Background and Aim: Amoebic liver abscess is common in tropical countries. The occurrence of an ileocecal mass or an amoeboma associated with amoebic liver abscess is rare. We present a case of a middle aged male with amoebic liver abscess and right iliac fossa mass.

Acute salpingitis presenting with acute abdomen in a pre-pubertal girl

Background: An acute abdomen in children is often a challenging scenario for clinicians as it is caused by various medical and surgical conditions. Although symptomatology and specific clinical findings point directly to few causes, thorough history and in-depth clinical examination help to systematically narrow down the differential diagnosis. Clinical Description: We report a rare case of acute salpingitis in an 8-year-old prepubertal female child presenting with acute abdominal pain and fever for 3 days. Examination revealed diffuse abdominal tenderness with guarding and rigidity along with an ill-defined, tender mass in the right iliac fossa. Management: Abdominal ultrasound showed a hyperechoic mass in the right iliac fossa and the appendix was not visualized. The child was kept nil oral and started on broad-spectrum antibiotics. However, the child developed abdominal distension and worsening of pain over the next 24 h. The child was taken up for emergency laparotomy, and a complex mass in the right iliac fossa adherent to small bowel and covered by omentum was noted. Histopathological examination of the excised right iliac fossa mass showed acutely inflamed right fallopian tube. Normal appendix was noted in the postoperative ultrasonogram. Conclusion: It is important to differentiate surgical causes from nonsurgical ones to avoid unnecessary surgery and its complications. Salpingitis may mimic acute appendicitis because of nonspecific symptomatology and radiological signs and should be considered as a differential diagnosis for acute abdomen, even in a prepubertal female child.

Clinico sonological evaluation of right iliac fossa mass

Back ground and Objectives: Mass in the abdomen, by reason of their wide spread implications, has since long exercised the minds of many workers. Mass in the right iliac fossa is not an uncommon entity. The temple of surprises, pandoras box- hackeyened phraseology is apt in case of mass In the right iliac fossa. This challenging task of recognising certain well defined clinicopathological aspects of mass in the right iliac fossa has stimulated in undertaking this study. Ultrasound is quick, non invasive and has bridged the gap between palpation and direct visualization. In this common clinical condition often disparity between clinical, ultrasound, and final diagnosis. The role of ultrasound in evaluation is necessary as some require emergency surgical intervention and some improve with conservative management. Materials and Methods: Retrospective study of 42 patients presented with clinical diagnosis of right iliac fossa mass were selected. Pediatric age group, gynaecological conditions, and parietal wall swellings were excluded. In these cases ultrasound examination by 5 and 7.5 Mh ransducers were used and clinical, ultrasound and final diagnosis ware compared. Results: Appendicular mass constituted 14 cases (33%), appendicular abscess 11cases (26%) leocaecal tuberculosis 8 cases (19%) carcinoma cecum 5 cases (12%) and crohn's disease 1 case (3%). Appendicular mass common in the age group 30-39 years, appendicular abscess in 60- 70 years, Ileocecal tuberculosis in 30-39 years, carcinoma caecum in > 40years, and 1 case of crohns disease between 40-49 years. Ultrasound was able to diagnose appendicular abscess which were clinically diagnosed as appendicular mass. ultrasound was able to find out the bowel thickening with target sign and pseudo kidney sign in Ileocecal tuberculosis. and Carcinoma cecum with moderate specificity. Conclusion: Appendicular pathology constituted 59% cases. it was able to detect appendicular abscess with high sensitivity and specificity. It helped in early assessment and early intervention of the required, reduces the cost and morbidity, It is an adjuvant diagnostic tool in cases of Ileocecal tuberculosis and carcinoma cecum. In the elderly who cannot withstand and in cases of misleading presentation it has a ole and it is really cost effective, non invasive procedure done in OPD set up without preparation with good result, is a first good line of investigation modality in right iliac ossa mass.

Small bowel obstruction and ileocolic fistula caused by post-myomectomy Gossypiboma transmural migration: A case report and review of the literature.

IntroductionPost-myomectomy Gossypiboma causing Ileo-colic fistula is tremendously rare; it may present as a tumor and stand a diagnostic challenge. The duration between the primary procedure and the presentation is unpredictable.Case presentationA 37-year-old Sudanese/African woman presented with a 4-month history of left iliac fossa mass, pain, anorexia, and persistent, recurrent vomiting with episodes of diarrhea during the last month PTP. She had two gynecological surgeries. Abdominal X-ray & abdominopelvic CECT showed a left iliac fossa pelvic-abdominal collection, distal small bowel partial obstruction, and contrast passage from the small bowel to the sigmoid colon. Diagnosis retained foreign body with abscess causing distal ileal subacute obstruction and an ileo-sigmoid fistula. Surgical exploration, extraction of Gossypiboma with small bowel resection, primary sigmoid colon repair, and a protective transverse colon stoma were done. Six weeks later, colostomy closed after distal loopogram and flexible-sigmoidoscopy.Clinical discussionA missed intraperitoneal gauze is the top differential diagnosis in patients presenting with acute abdomen after recent abdominal surgery. Transmural migration is slow but leads to difficult clinical situations, peritonitis, or fistulas. Our case reflects the light on the importance of the golden rule of perioperative gauze count and documentation. Thus, minimizing the surgical complications and preventing severe postoperative morbidities.ConclusionEntero-colic fistula due to trans mural migration is not frequently encountered, and its complications can lead to morbidities and even mortality if not promptly diagnosed and treated. Strict adherence to the golden rule of counting and prevent such life-threatening complications and improves patients' safety.