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CLINICOSONOLOGICAL EVALUATION OF RIGHT ILIAC FOSSA MASS

Ramachandra J, K. Athirath Reddy

Abstract


Introduction:  A clinical entity of mass abdomen has always posed a diagnostic difficulty for the clinicians and the surgeons. Of all the quadrants in abdomen, right iliac fossa pathology seems to be the most common. It is always a difficult task to diagnose a right iliac fossa mass because of its varied presentation and this has led us to undertake this study. A meticulous examination of abdomen is one of the most rewarding diagnostic procedures available to the surgeon. The clinical diagnosis is possible in most cases. Ultrasound is quick, non invasive, effective and has bridged the gap between palpation and direct visualization. The role of ultrasound in evaluation is necessary as some require emergency surgical intervention and some improve with conservative management.

Materials and Methods: Prospective study of 42 patients who presented with clinical diagnosis of right iliac fossa mass were selected. Paediatric age group, gynaecological conditions, and parietal wall swellings were excluded. In these cases ultrasound examination by 5 and 7.5 Mh transducers were used and clinical, ultrasound and final diagnosis were compared.

Results: Appendicular mass constituted 14 cases (33%), appendicular abscess 11cases (26%), Ileocaecal tuberculosis 8 cases (19%), carcinoma caecum 5 cases (12%) and crohn’s disease 1 case (3%). Appendicular mass is common in the age group 30-39 years, appendicular abscess in 60-70 years, Ileocaecal tuberculosis in 30-39 years, carcinoma caecum in > 40years, and 1case of crohn’s 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 Ileocaecal tuberculosis and Carcinoma caecum with moderate specificity.

Conclusion: Appendicular pathology constituted 59% cases and was able to detect appendicular abscess with high sensitivity and specificity. In the elderly who cannot withstand and in cases of misleading presentation it has a role 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 fossa mass.

Keywords


Appendicular mass, Appendicular abscess, Ileocecaltuberculosis, Carcinomacecum, Target sign, Pseudokidney sign.

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References


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