Right iliac fossa mass

1. WELCOME TO MY
PRESENTATION

2. CASE: RIGHT ILIAC FOSSA MASS

3. PARTICULARS OF THE PATIENT:
▪ Name: Mrs Minara Begum
▪ Age: 45 years
▪ Sex: female
▪ Religion: Islam
▪ Marital Status: Married
▪ Occupation: Housewife
▪ Address: Sonapur, Noakhali
▪ Date of admission: 24/07/18
▪ Date of examination: 30/07/18

4. CHIEF COMPLAINTS:
I. Pain in the right lower abdomen for 5-6 months
II. Swelling in the right lower abdomen for 3-4 months
III. Loss of appetite for same duration
HISTORY OF PRESENT ILLNESS:
According to the statement of the patient she was reasonably well
about 6 months back. Since then she has been suffering from pain in
the right lower abdomen which is mild, dull aching continuous in
nature. Pain radiates to back. There is no specific aggravating or
relieving factors. She noticed a swelling in the right lower abdomen
which is gradually increasing in size since last 3-4 months. She has

5. complaints of anorexia, weakness and she has been loosing
weight. She also Complaints of occasional vomiting. Vomitus is
scanty in amount and bitter in taste. She has alternation of
bowel habit and her bladder habit is normal. There is no history
of fever, haematemesis, melaena, chest pain, haemoptysis or
bone pain. She is normotensive and non-diabetic.

6. HISTORY OF PAST ILLNESS:
There is no significant medical or surgical history.
DRUG HISTORY:
She has no history of allergy to any drug.
FAMILY HISTORY:
She has 3 children of 2 sons & 1 daughter and 2 brothers & 3 sisters.
All are in good health and her parents died naturally.

7. PERSONAL HISTORY:
She was used to take meal regularly. But at present she has anorexia.
IMMUNIZATION HISTORY:
She can’t mention her immunization.
SOCIO-ECONOMIC HISTORY:
She belongs to lower class family. Her husband is a day labourer.

8. GENERAL EXAMINATION:
▪ Appearance: Anxious & ill looking
▪ Body built: Below average
▪ Co-operation: Cooperative
▪ Decubitus: On choice
▪ Anaemia: ++
▪ Jaundice: Absent
▪ Cyanosis: Absent
▪ Oedema: Absent
▪ Clubbing: Absent

9. ▪ Koilonychia: Absent
▪ Leuconychia: Absent
▪ Dehydration: Mildly dehydrated
▪ Skin condition: Normal
▪ Lymphnodes: Not palpable
▪ Thyroid: Not enlarged
▪ Pulse: 74 beats/min
▪ BP: 110/80 mm of Hg
▪ Temperature: 98
▪ Respiratory rate: 14/min

10.  SYSTEMIC EXAMINATION:
● ABDOMEN:
1) Inspection:
▪ Shape of the abdomen: Scaphoid
▪ Flanks: Not full
▪ Umbilicus: Centrally placed & inverted
▪ Skin condition: Normal
▪ Hair distribution: Normal
▪ Visible peristalsis: Absent
▪ Visible pulsation: Absent

11. ▪ Hernial orifice: Intact
2)Palpation:
▪ Temperature: Normal
▪ Tenderness: Non tender
▪ Muscle guard: Absent
▪ There is an intra-abdominal lump in right iliac fossa
-Globular in shape, measuring about 8×6 cm.
-Surface irregular
-Margin ill defined

12. -Hard in consistency
-Mildly tender
-Fixed
▪ Liver, Spleen & Kidneys: Not palpable
3.Percussion:
▪ Dull over the lump & tympanic in all over abdomen
▪ Upper border of liver dullness: In right 5th intercostal
space on midclavicular line.
▪ Shifting dullness & Fluid thrill: Absent

13. 4)Auscultation:
▪ Bowel Sound: Present
Digital Rectal Examination: Shows no abnormality
Other Systemic Examinations: Reveal no abnormality
Salient Features:
Mrs Minara Begum, 45 years old housewife, normotensive &
non-diabetic, haling from Sonapur, Noakhali admitted into
this hospital with the complaints of pain in the right lower
abdomen for 5-6 months, swelling in the right lower ab-
domen for 3-4 months & loss of appetite for same duration.

14. Pain is mild, dull aching, continuous in nature & radiates to back.
There is no specific relieving or aggravating factor. Swelling is
gradually increasing in size. She has complaints of anorexia,
weakness, loss of weight & alternation of bowel habit. Her bladder
habit is normal. There is no H/O fever, haematemesis, melaena, chest
pain, haemoptysis or bone pain. On general examination she is
anaemic, mildly dehydrated, nutritional status below average. Vital
parameters are within normal limit. On abdominal

15. examination- there is an intra-abdominal lump in right iliac fossa which
is globular in shape, measuring about 8×6 cm, surface irregular, margin
ill defined, hard in consistency, fixed & mildly tender. There is no
organomegaly. D/R/E & other systemic examinations reveal no
abnormality.
Clinical Diagnosis: Ca Caecum
Differential Diagnosis:
1. Ileocaecal tuberculosis
2. Appendicular mass
3. Right sided ovarian cyst
4. Chrons disease

16. Investigations:
1) For diagnosis: Colonoscoy & biopsy
Findings-
▪ Perianal area- Normal
▪ Anal canal- Normal
▪ Rectum & colon- Seen upto caecum. An ulcero-proli-ferative
growth is seen at caecum. Mucosa & vascularity of rest of the
colorectum appeared normal.
▪ Biopsy- Taken
▪ comment- Ca caecum

17. 2) To see metastasis: USG of whole abdomen
3) For G/A fitness:
-CBC with ESR
-Blood Grouping
-Blood sugar
-Serum creatinine
-Urine R/M/E
-Chest X-ray P/A view
-ECG
-Echocardiography

18. Treatment:
1) Right hemicolectomy with removal of draining lymphnode &
end to end anastomosis 2) Adjuvant therapy:
Radiotherapy, Chemotherapy

19. THANK YOU