A case presentation on rif lump due to Acute appendicitis

1. CASE PRESENTATION
RIGHT ILLIAC FOSSA LUMP
(A LUMP DUE TO ACUTE APPENDICITIS)

2. Patient Particulars:
• Name- S
• Age- 23 years
• Sex- Female
• Religion- Hindu
• Occupation-Housewife
• Address- B
• Date of Admission- 7/12/2022
• Date of Examination- 8/12/2022

3. Chief Complaints:
• Pain in the right lower abdomen – 4 days
• Fever- 3 days
• Vomiting- 3 days

4. History of Present Illness:
My patient complains of pain in the right lower abdomen for the last
4 days, which was sudden in onset, progressively increasing in
intensity. It was initially colicky in nature, around the peri-umbilical
region. Later, the pain shifted to the right lower abdomen. The pain
does not have any aggravating factors and was relieved on taking
medications.
The patient had history of intermittent fever for the last 3 days. It was
not associated with chills and rigor or diurnal variation.
The patient had multiple episodes of vomiting for the last 3 days,
which is about half a cup in amount, non-foul smelling, non-
projectile, contains partially digested food matter.

5. The patient does not have any history of altered bowel habits, no
history of passage of black tarry stool or blood in stool.
There is no history of unintentional weight loss, abdominal
distension, jaundice.
There is no history of chronic cough, easy fatigability or evening rise
of temperature.

6. Past history
The patient does not have history of similar episode of pain in the
past.
No history of major or minor surgical intervention done in the past.
The patient did not have any history of TB, Carcinoma, Typhoid in the
past.

7. Personal History
Diet: mixed Indian diet with rice as the staple diet.
The patient has no history of smoking or betel nut chewing.
Sleep: normal
Appetite: reduced.
Bowel and bladder habits are normal.

8. Menstrual and Obstetrics history
Menarche: 13years
Cycle : 29-30days
Duration:4days
Normal flow
LMP: February 2022
Patient is G1P1 and had NVD 1 month back. There were no any
complications in peripartum period.

9. Family History
The patient lives with her husband, in –laws and 1 son. All are in good
health.
There is no history of similar illness in the family.
No history of contact TB or any carcinoma running in the family.

10. Socio-economic history
The patient belongs to lower middle class family. They live in pucca
house with separate sanitation. They use gas for cooking and acquire
drinking water from supply.

11. Allergy History
Patient is not allergic to any known substance.

12. Immunisation History
BCG scar is seen.
2 doses of COVID vaccine taken.

13. General Examination
The patient is conscious, alert and well- oriented to time, place and
person.
Comfortable in any decubitus
Normal built.
Pallor- absent.
Icterus, cyanosis, clubbing- absent.
Neck veins: not engorged
Neck nodes: not palpable.

14. BP- 110/80 mm Hg in supine position
Pulse rate- 97/min, regular, normal in volume and character, normal
condition of the arterial wall, no radio-radial, radio-femoral delay.
Respiratory rate- 15/ min
Spo2- 98% at room air

15. Sytemic Examination
Abdominal Examination
Inspection
The abdomen is neither distended nor scaphoid.
The umbilicus is inverted and positioned midway between the xiphoid and
pubic symphysis.
Each quants is moving equally with respiration.
Striae marks and linea nigra noted.
No visible peristalsis.
No visible swelling.
No visible veins.
Hernial sites are intact.

16. Palpation:
Local rise of temperature is noted over the right iliac fossa and right
lumbar region.
There is a single lump of size 5cm x 4cm noted involving the right iliac
fossa and right lumbar region which is tender on palpation, with
localised guarding.
Lump is Firm in consistency, smooth surface, irregular margins and
lower border felt just above the groin crease.
It is non-mobile.
There are no pulsations noted over the lump
No other palpable organomegaly noted.
Hernial sites, back and spine are all normal.

17. Percussion:
There is tympanic note present all over the abdomen.
There is no evidence of free fluid in the abdomen.
Auscultation:
Normal peristalsis heard.

18. Digital Rectal Examination:
Peri-anal area is normal
Sphincter tone- adequate
No palpable mass
Rectal mucosa is smooth
Normal stool stained finger

19. Cardiovascular System:
S1, s2 heard, with no added sounds
Respiratory system:
Bilateral air entry present , clear lung fields.
CNS:
Cranial nerves are intact and there is no neurological deficit.
GCS E4V5M6

20. Summary:
• a 23 years old housewife presented with history of pain in the right
lower abdomen for the last 4 days. At the onset, the patient had
colicky pain around the peri-umbilical region which later shifted to
the right lower abdomen. It is associated with nausea and multiple
episodes of vomiting and intermittent fever for the last 3 days. There
is no history of unintentional weight loss, altered bowel habit, or
passage of blood in stool.

21. On general examination, there is no pallor, cyanosis or clubbing, BP is
110/80 mm Hg, pulse rate is 97/ min. On abdominal examination, the
contour and umbilicus was normal. No visible peristalsis or pulsatile
movement noted. A lump of size 5cm x 4 cm involving the right iliac
fossa and right lumbar region was noted which is tender on palpation,
with localised guarding. It is firm in consistency, smooth surface,
irregular margins non-mobile. No free fluid in the abdomen and normal
bowel sounds were heard on auscultation. Digital rectal examination,
and other systemic examinations are normal.

22. Provisional Diagnosis:
A case of Right Iliac Fossa lump due to an appendicular lump.

23. Differential Diagnosis:
1. Ileo-caecal Tb
2. Carcinoma Caecum
3. Right Ovarian cyst
4. Mesenteric Lymphadenopathy.
5. Intussusception