Mass In Left Iliac Fossa Research Articles

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.

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.

Functional constipation in Bangladeshi school aged children: A hidden misty at community.

BACKGROUNDConstipation is a common problem in children and a frequent cause of hospital visit in both primary & specialized care, which needs proper evaluation & management. Presentation of constipation is variable among children. In Bangladesh there has been no published data regarding constipation in community among school aged children.AIMTo determine the magnitude of functional constipation and its risk factors in community among Bangladeshi school children.METHODSThis descriptive cross sectional study was conducted in different schools of Dhaka division, Bangladesh. All school aged children between 5-16 years of age who attended school were included in this study. Samples were collected randomly. Proper clinical history & physical examinations (without digital rectal examination) & available investigations (if done previously) were recorded. Diagnosis of functional constipation was done by Rome IV criteria and was compared with children without constipation. Children with any red flag sign, known chronic disease or any findings suggestive of organic disease and on treatment of constipation were excluded. Statistical analysis of the results was done by using Windows based software device with Statistical Packages for Social Science 20. For all statistical tests, P value of less than 0.05 was considered as statistically significant.RESULTSTotal study populations were 707 and male was 443 and female 264. Among them, 134 (19%) children had constipation. In constipated children, 78 children fulfilled the Rome IV criteria for functional constipation and it was 11% of total population. Mean age of children having functional constipation was 11.24 ± 3.54 years and Male female ratio was 1:1.78. Anorexia, nausea, abdominal pain, hard stool, blood with hard stool, alternate hard and loose stool and fecal mass in left iliac fossa were analyzed between two group and all were significantly higher in children with functional constipation group. Children of school, where toilet numbers were inadequate had 2.5 times more constipation risk in comparison to children of school with adequate toilet number (OR = 2.493, 95%CI: 1.214-5.120). Children who feel embarrassed to use toilet at school, had 3.6 times higher risk of constipation (OR = 3.552, 95%CI: 1.435-8.794). Here children with H/O affected sibs and parents/grandparents had 4 and 2.6 times more chance of constipation respectively in comparison to children without H/O affected sibs (OR = 3.977, 95%CI: 1.884–8.397) and parents/grandparents (OR = 2.569, 95%CI: 1.172-5.629). Children with inadequate fluid intake had 2 times more risk of constipation in comparison to children with adequate fluid intake (OR = 1.972, 95%CI: 1.135-3.426). Children who passed electronic screen time of > 2 h/d had 2 times more chance of constipation in comparison to children who passed electronic screen time < 2 h (OR = 2.138, 95%CI: 1.063-4.301).CONCLUSIONConstipation is not uncommon in Bangladeshi school aged children. Inadequate toilet number, family history of constipation, inadequate fluid intake, feeling embarrassed to use toilet at school, and electronic screen time for > 2 h/d were found as risk factors in the present study for functional constipation.

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.

Mesenteric abscess presents as left iliac fossa mass in postoperative case of inguinal hernia surgery with undescended testis

An abscess is a collection of pus (dead and dying neutrophils plus proteinaceous exudate) that has built up within the tissue of the body. Mesenteric abscess is a rare, usually accounts for small percentage of intra-abdominal abscess after inguinal hernia surgery which is presented as left iliac fossa mass in postoperative period of open inguinal hernia surgery of left side and also presented with undescended testis of left side which is actual cause of formation of inguinal hernia of same side. Late onset mesh infection and post-operative peritonitis are very common in case of open hernia surgery. Intra-abdominal abscess cause significant morbidity and mortality. Surgery disturb the equilibrium between coagulation and fibrinolysis in the abdominal cavity in favour of coagulation system. Diminished fibrin degradation is a common pathway for the formation of abscess. We present a case of 40 years of male came with pain in left iliac fossa and lower abdomen for last 2 months with a swelling at LIF and hypogastric region for last 3 months with a previous history of hernia surgery of left side 2 month back which was diagnosed as mesenteric abscess and treated with exploratory laparotomy under general anaesthesia and abscess was drained.

Gastrointestinal basidiobolomycosis: An emerging potentially lethal fungal infection

Background: Gastrointestinal basidiobolomycosis (GIB) is a newly emerging rare tropical fungal infection which affects immunocompetent individuals. Patients and Methods: Our database was reviewed to identify patients with biopsy-proven gastrointestinal basidiobolomycosis. Results: Six patients were recognized, two females and four males, with a median age of 23.5 years (range 11–70). All patients came from the same region and all had eosinophilia and they were all immunocompetent. The clinical and radiological features simulated colorectal malignancy in four patients, inflammatory bowel disease in one patient, and left iliac fossa mass in another patient. The diagnosis was established after extensive colonic surgery in four patients, after open biopsy in one patient and after ultrasound-guided biopsy in another. All patients received prolonged antifungal treatment. In those who received extensive colonic surgery, one patient died, two patients recovered, and one is still receiving antifungal treatment. Patients in whom the diagnosis was established by biopsy only, one patient recovered while the other is showing steady improvement. Conclusion: GIB is a potentially lethal fungal infection, which affects immunocompetent individuals in temperate and hot arid regions of the world, including Saudi Arabia, Iraq, Iran, and Arizona desert in the United States. The patient usually presents with features suggestive of colonic malignancy, inflammatory bowel disease, or abdominal mass. Establishing the diagnosis by endoscopic- or radiology-guided biopsy, serological tests, fungal cultures, or molecular techniques enables the institution of antifungal treatment, which may lead to complete cure without surgery. With or without surgery prolonged antifungal therapy is always required.

Rare case of primary leiomyosarcoma of sigmoid mesocolon

We experienced a rare case of primary leiomyosarcoma of sigmoid mesentery. A 45-year-old woman was presented to us with left iliac fossa mass and discomfort for 4-month duration. CT scan...

COLONIC CANCER

A prospective study was conducted to see presentation and management of coloniccancer presenting to a surgical unit in a teaching hospital at Faisalabad. Objectives: To knowdifferent presenting symptomatology like abdominal mass, pain, intestinal obstruction, alteredbowel habits, rectal bleeding, age co-relation, sex distribution, anatomic location among coloniccancer patients and management done for these patients. Study Design: A prospective study.Period: February 2009 to March 2010 for one year. Material and Methods: Total 8 patients werediagnosed and treated for colonic cancer presenting in a single surgical ward. Patients with ageabove 14 years were included in study while patients presenting with trauma and metastaticdisease for other carcinoma were excluded. Results: Among 8 patients diagnosed for coloniccancer, age’s range from 26 to 50 years at maximum, 2 patients (25 %) were males and 6 patients(75 %) were females. Only one patient (12.5%) presented with single complaint of left iliac fossamass, 2 patients (25 %) with only single complaint of rectal bleeding as a presenting symptomwhile all other 5 patients (62.5%) presented with more than one or two symptoms at the sametime. Among 5 patients presented with more than one symptom all had presented with abdominalmass associated with additional symptoms like, one patient (12.5%) developed intestinalobstruction with left sided abdominal mass, another one patient (12.5%) left sided abdominalmass with alternate diarrhea and constipation, another one patient (12.5%) right sided masswith pallor, one patient (12.5%) had constipation with left sided mass while another one patient(12.5%) developed abdominal pain, weight loss and palpable left sided abdominal mass. Patientswere staged according to TNM staging system. All patients were above stage II and Dukes B. Allpatients were operated in Surgical Unit II at Allied Hospital Faisalabad. Left hemi-colectomy wasdone for 2 patients; right hemi-colectomy was done for single patient presented with mass andanemia on right side, sigmoid resection with colostomy for one patient, Hartmann’s procedurefor another one patient and single stage resection with primary anastomosis for one patient. 2patients underwent abdomino-perineal resection with end colostomy. Conclusion: This studytells that majority of the patients with colon cancer presented with left sided abdominal mass andother associated symptom, the age’s range from 26 to 50 years. Disease affected 6 females out oftotal 8 patients. Two patients underwent APR with end colostomy while other patients were treatedwith alternate procedures like primary anterior resection with anastomosis or end colostomy

An unusual radiological presentation of mucinous adenocarcinoma of the colon

We report a case of an elderly patient presenting with the left iliac fossa mass. The provisional diagnosis included an inflammatory diverticular mass or sigmoid colon cancer. Interestingly, computed tomography (CT) of the abdomen and pelvis demonstrated the left incarcerated Spigelian hernia containing an inflamed loop of the colon with signs of an early strangulation. However, at operation, a mucinous tumor was found involving the descending and upper sigmoid colon. The tumor eroded through the anterior abdominal wall, which was excised "en bloc." In the presented case, CT findings suggestive of a benign etiology were misleading. This potentially could have had significant consequences if the patient was treated conservatively. This case highlights that clinical history and examination remain the core components of a safe surgical practice. Clinical judgment cannot be substituted even by the best quality imaging. Therefore, we feel that it is important to share our experience of the successful management of the presented case.

English

A prospective study was conducted to see presentation and management of coloniccancer presenting to a surgical unit in a teaching hospital at Faisalabad. Objectives: To knowdifferent presenting symptomatology like abdominal mass, pain, intestinal obstruction, alteredbowel habits, rectal bleeding, age co-relation, sex distribution, anatomic location among coloniccancer patients and management done for these patients. Study Design: A prospective study.Period: February 2009 to March 2010 for one year. Material and Methods: Total 8 patients werediagnosed and treated for colonic cancer presenting in a single surgical ward. Patients with ageabove 14 years were included in study while patients presenting with trauma and metastaticdisease for other carcinoma were excluded. Results: Among 8 patients diagnosed for coloniccancer, age’s range from 26 to 50 years at maximum, 2 patients (25 %) were males and 6 patients(75 %) were females. Only one patient (12.5%) presented with single complaint of left iliac fossamass, 2 patients (25 %) with only single complaint of rectal bleeding as a presenting symptomwhile all other 5 patients (62.5%) presented with more than one or two symptoms at the sametime. Among 5 patients presented with more than one symptom all had presented with abdominalmass associated with additional symptoms like, one patient (12.5%) developed intestinalobstruction with left sided abdominal mass, another one patient (12.5%) left sided abdominalmass with alternate diarrhea and constipation, another one patient (12.5%) right sided masswith pallor, one patient (12.5%) had constipation with left sided mass while another one patient(12.5%) developed abdominal pain, weight loss and palpable left sided abdominal mass. Patientswere staged according to TNM staging system. All patients were above stage II and Dukes B. Allpatients were operated in Surgical Unit II at Allied Hospital Faisalabad. Left hemi-colectomy wasdone for 2 patients; right hemi-colectomy was done for single patient presented with mass andanemia on right side, sigmoid resection with colostomy for one patient, Hartmann’s procedurefor another one patient and single stage resection with primary anastomosis for one patient. 2patients underwent abdomino-perineal resection with end colostomy. Conclusion: This studytells that majority of the patients with colon cancer presented with left sided abdominal mass andother associated symptom, the age’s range from 26 to 50 years. Disease affected 6 females out oftotal 8 patients. Two patients underwent APR with end colostomy while other patients were treatedwith alternate procedures like primary anterior resection with anastomosis or end colostomy

Superior Mesenteric Vein Thrombosis as a complication following Jejunal lymphoma resection: A Case Report

We report a 65 year old female who presented with Left iliac fossa mass for three months with pain for ten days. Ultrasound and CT scans have revealed a lymphoma involving the descending colon. Colonoscopy was normal. At mini laparotomy, the mass was found to be arising from jejunum, with impending obstruction. A Jejunal resection was carried out. Following stable first three post-operative days, the patient developed septicemia. Review CT scan revealed, non-perfused, gangrenous bowel. At relook laparotomy, there was extensive small bowel gangrene along the drainage territories of Superior mesenteric vein. Patient succumbed to septic shock on fourth post-operative day.

Transanal protrusion of intussusceptions in children.

The aim of the following study is to report our management experience and outcome of transanal protrusion of intussusceptions. Retrospective analysis of all cases of intussusceptions protruding through the anal opening from January 2008 to June 2013. Of 62 cases of intussusceptions, transanal protrusion occurred in 10 patients (16% anal protrusion rate) with a male:female ratio of 2:3. They were aged 4-96 months (mean 22.6 ± 30.7, median 7.5 months). Six were infants while four were above 1 year. Duration of symptoms ranged from 2 to 14 days (mean 5.9 days ± 3.4) with only two patients presenting within 48 h. Clinical features included vomiting (100%), abdominal pains (100%), bloody mucoid stool (100%), abdominal distension (90%), and palpable left iliac fossa mass (70%). Three patients had preceding diarrhoea (30%) and two had preceding upper respiratory tract infection (20%). Duration of hospital stay ranged from 5 to 23 days (mean 12 days ± 5.6). Findings at surgery included seven ileocolic and two colocolic intussusceptions (one patient died before surgery). Operative procedures were right hemicolectomy (5), operative manual reduction (3), left hemicolectomy (1) giving a 67% bowel resection rate. One patient died giving a 10% mortality rate. Transanal protrusion occurred more in females and is associated with late presentation, older age, high bowel resection rate, and high mortality.

Thyroglobulin and thyroglobulin autoantibodies: interpret with care

A middle-aged lady with a past history of hyperlipidemia presented to our institution with worsening of a lower back pain that has been present for a year. The back pain radiated down her left lower limb and was associated with left foot numbness and nocturnal pain. On examination, a mass was palpated in the left iliac fossa. A full body CT scan revealed a soft tissue lesion with central necrosis and bony destruction of the left iliac bone, a similar bony lesion in the left 6th rib, and a thyroid mass. An ultrasound of thyroid gland showed a cystic nodule with interrupted calcified rim. A biopsy of the left iliac fossa mass was reported as metastatic follicular thyroid carcinoma. She underwent total thyroidectomy and was given four courses of radioiodine after a failed debulking surgery. During follow up, she was comanaged with another institution where she received the radioiodine therapy. Her thyroglobulin autoantibodies (TgAb) and thyroglobulin (Tg) concentrations were measured by both institutions. Interestingly, at our institution, her TgAb were always undetectable and her Tg showed rapidly decreasing trend (both Immulite 2000, Siemens). At the other institution, her TgAb were strongly positive and her Tg concentrations showed a different trend and were closely mirrored by TgAb concentrations (both Kryptor, B R A H M S) (Fig. 1). The Immulite 2000 TgAb method employs a chemiluminescence sequential immunometric format. On the other hand, the Kryptor TgAb method is a fluorescence competitive immunoassay. This report was exempted from local institutional board review. This case illustrated several important points about interpretation of Tg and TgAb. Tg is produced by the thyroid gland and is a tumor marker for differentiated thyroid cancers (DTC). TgAb are autoantibodies that may develop in autoimmune thyroid diseases or DTC. TgAb must be simultaneously measured with Tg as they may interfere with and falsely lower Tg measurements. When TgAb are positive, the Tg results should be interpreted with care and the TgAb may be used as surrogate tumor marker, as detailed in this clinical review [1]. Rising or stable TgAb trends are associated with increased risk of residual disease, metastasis, or recurrence, while a declining trend suggests the risks are low [1]. This approach remains controversial and more evidence is needed to establish its role in routine clinical care. An emerging and promising alternative is the use of mass spectrometric methods to measure Tg that may avoid the interference from TgAb. TgAb have been shown to be heterogeneous and have different epitopes between individuals, and are associated with histologic features of lymphocytic thyroiditis [2]. They are detected variably using different laboratory assays and may be classified differently in nearly 40 % of patients with papillary thyroid cancer with lymphocytic thyroiditis [3]. In patients with lymphocytic thyroiditis, it is probably prudent to confirm a negative TgAb with an alternate assay when Tg is unexpectedly undetectable [2, 3]. This patient did not have histologic evidence of lymphocytic thyroiditis yet showed highly discrepant TgAb results. The discrepancy may be accounted for by the use T. P. Loh (&) Department of Laboratory Medicine, National University Hospital, 5 Lower Kent Ridge Road, 119074 Singapore, Singapore e-mail: lohtp@yahoo.com

Retained surgical sponge: An enigma

Retained surgical sponge in the body following a surgery is called gossypiboma. A 27-year-old female who had undergone lower segment cesarean section 4 months earlier was admitted with complaints of pain abdomen with a palpable mass in left iliac fossa. X-ray, ultrasonography, and CT scan findings were suggestive of retained surgical sponge. Surgical sponge was removed following laparotomy. Surgeons must be aware of the risk factors that lead to gossypiboma, and measures should be taken to prevent it. Besides increasing morbidity and possible mortality, it may result in libel suit for compensation.

533. External Hemipelvectomy Experience at National Cancer Institute in Mexico

533. External Hemipelvectomy Experience at National Cancer Institute in Mexico

Femoral vein thrombosis due to a large iliopsoas bursitis secondary to polyethylene wear debris in total hip arthroplasty

A 76-year-old male patient with a history of implantation of a total hip arthroplasty (Perfecta (Orthomet)®), who presented with an iliac fossa mass, increased diameter of the thigh, and pain during hip flexion and extension. CT and ultrasound show the presence of a giant cystic mass in left iliac fossa about 7cm in diameter next to the prosthesis. A pseudo-tumor secondary to wear debris after placement of a total arthroplasty is rare. We present a case of a large iliopsoas bursitis caused by polyethylene particles, which caused compression and thrombosis of the superficial femoral vein.

Trombosis de la vena femoral superficial por gran bursitis en psoas secundaria a enfermedad de las partículas en artroplastia total de cadera

A 76 year old male patient with a history of implantation of a total hip arthroplasty Perfecta (Orthomet®), who presented with an iliac fossa mass, increased diameter of the thigh, and pain during hip flexion and extension. CT and ultrasound show the presence of a giant cystic mass in left iliac fossa about 7cm in diameter next to the prosthesis. A pseudo-tumour secondary to wear debris after placement of a total arthroplasty is rare. We present a case of a large iliopsoas bursitis caused by polyethylene particles, which caused compression and thrombosis of the superficial femoral vein.

Spontaneous Expulsion of a Biliary Stent via the abdominal wall: A rare complication: Case Report

We report a rare complication of a biliary stent inserted via endoscopic retrograde cholangio-pancreatography (ERCP) for benign biliary disease in a 60 years-old female presented with abdominal pain and a tender left iliac fossa (LIF) mass. She had change of the colour of the skin over the hypogastric region. Crepitus was felt in the subcutaneous tissue. Surgical drainage of the abscess was undertaken. A black, 14-cm biliary stent was found in the centre of the necrotic tissue. The patient, thereafter, made an uneventful recovery and the LIF mass disappeared. The wound was closed with secondary sutures about three weeks later, and complete healing was achieved thereafter. Here we discuss this rare complication. Keywords : Biliary stent migration, colonic perforation, abdominal mass, large bowel obstruction, abdominal wall abscess, ERCP complication. Sudan Journal of Medical Sciences Vol. 3 (3) 2008: pp. 255-258

Haemangiopericytoma of the sigmoid mesentery

Haemangiopericytoma is a rare, vascular soft tissue tumour originating from the pericytes surrounding capillaries. We report a case of haemangiopericytoma in the sigmoid mesocolon and are aware of only one previously case. A 61-year-old man was referred with a left iliac fossa mass. At operation, a 10-cm diameter mass was found to be arising from the sigmoid mesentery (Fig. 1). The mass did not involve the bowel wall and there was no clinical evidence of metastatic disease. A sigmoid colectomy with primary anastomosis was performed. The patient made an uneventful recovery. Pathological assessment of the specimen revealed a 95 x 70 x 50 mm(3), purple, lobulated mass within the sigmoid mesocolon adjacent to the bowel. Immunohistological analysis (positive CD34, focal factor VIII) was consistent with a diagnosis of a haemangiopericytoma. Complete excision with adequate margins remains the treatment of choice. We therefore suggest that patients be carefully followed for long periods and advised of the risk of long-term relapse.

Diverticule géant du côlon sigmoïde fistulisé dans le jejunum

An 80-year-old woman with sigmoïd diverticula was treated by corticosteroïd for Horton disease. She presented abdominal pain, and abdominal mass in left iliac fossa. Radiological examinations revealed a colo-jejunal fistula. At laparotomy it was a giant diverticulum of colon sigmoïd with fistula in the jejunum. The pathogeny of giant diverticulum and the rôle of corticosteroïd are discussed.