Aishwarya, Krishnan Unni (2013) Various Clinical Entities Presenting as Intraabdominal Right Iliac Fossa Mass: A Comparison of the Sensitivities of the Clinical, Radiological and Histopathological Diagnoses. Masters thesis, Madras Medical College, Chennai.
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Abstract
INTRODUCTION: There are many abdominal conditions that present clinically as palpable lumps in the abdomen. The site and clinical characteristics of the lump as elicited by examination helps to get a diagnosis in most of these cases. However many require investigations like imaging to confirm clinical clues and some will need intra operative/pathological analysis for a definitive diagnosis. The abdomen is traditionally divided into 9 regions for description by 2 vertical and horizontal lines. The 2 vertical lines are extensions of the midclavicular lines and extend to the midinguinal points. The upper horizontal line is a transpyloric line passing midway between the umbilicus and the xiphisternum. The lower transtubercular line connects the 2 of the tubercles of iliac crest. The 9 regions are; 1. Right hypochondrium, 2. epigastrium, 3. Left hypochondrium, 4. Right lumbar, 5. Umbilical region, 6. Left Lumbar, 7. Right Iliac Fossa, 8. Hypogastrium, 9. Left iliac fossa. The anatomic structures occupying the right iliac fossa are the caecum, appendix, the terminal ileum. Retroperitoneally the iliac vessels, right ureter, lymphnodes, psoas muscle are situated. Pathologically enlarged ovaries, uterus, cysts can come to lie in the right iliac fossa. The common pathologic conditions giving rise to a palpable lump in the right iliac fossa are; 1. Appendicular mass, 2. Carcinoma of the Caecum, 3. Ileocecal Tuberculosis, 4. Psoas abscesses, 5. Intussuceptions, 6. Ovarian tumors. This dissertation aims to know the clues in the patient history and findings on examination that will help to arrive at a particular clinical diagnosis and then compare the sensitivity of the clinical diagnosis with diagnosis at imaging. The accuracy of clinical diagnosis and imaging diagnosis is then compared with intra operative and histopathologic findings. AIMS AND OBJECTIVES: 1. To study the various clinical entities presenting as Right Iliac Fossa mass and their incidence. 2. To compare the sensitivity of clinical diagnosis with radiological diagnosis using imaging modalities like Ultrasonography and CT scan. 3. To compare the sensitivity of clinical and radiological diagnoses with the intraoperative diagnosis in cases where surgical exploration is undertaken and the final histopathological report. MATERIALS AND METHODS: 50 Patients presenting to the general surgery department with clinically palpable right iliac fossa mass over a period of 6 months were included in the study. Pediatric patients and patients with only right iliac fossa pain but no mass were excluded. Study Centre: Department Of General Surgery, Madras Medical College And Rajiv Gandhi Government General Hospital, Chennai-600003 The patients were studied over a period of 6 months from June 2012-Dec 2012. All patients were examined by me and history and physical examination findings were noted based on the proforma enclosed. All patients underwent Ultrasonography of the abdomen and CT scan abdomen was taken for in patients who had a diagnosis other than appendicular mass. 35 cases underwent surgery and 33 of these cases had specimens removed and their histopathological report was compared with the pre operative clinical and radiological diagnosis CONCLUSIONS: 1. Appendicular mass is the commonest condition presenting as right iliac fossa mass. 2. Clinical diagnosis and imaging diagnosis is in concordance only in 50% cases of appendicular mass. 3. Clinical diagnosis is accurate in only 50% cases of appendicular Mass. 4. Imaging diagnosis is accurate in 86% cases of appendicular mass. 5. Ileocecal tuberculosis is the 2nd most common condition presenting as right iliac fossa mass. This is unlike in western populations where Crohn’s disease and malignancy of the caecum are commoner causes. 6. There was a female preponderance in the incidence of ileocecal tuberculosis. Female: Male ratio was 62.5 : 37.5 in this study. This is in concurrence with other studies from the Indian subcontinent. 7. Clinical diagnosis and imaging is highly accurate in diagnosing ileocaecal tuberculosis. There was 100% concurrence between both clinical diagnosis and imaging diagnosis. Also both clinical diagnosis and imaging diagnosis were in 100% agreement with histopathologic result. 8. Past history of tuberculosis is present in 75 % of cases of ileocecal tuberculosis. 9. Clinical impression was more accurate than imaging result in case of Carcinoma caecum. In this study clinical diagnosis agreed with final histopathology report in 100% of cases while imaging was accurate only in 75% of cases. 10. Carcinoma of caecum was found only in males in this study. 11. Clinical assessment and imaging were 100% accurate in diagnosing Psoas abscess. 12. Clinical assessment and imaging were 100% accurate in diagnosing Ovarian tumors. 13. Clinical assessment and imaging were 100% accurate in diagnosing intussusception. 14. In this study both cases of intussusception were due to small bowel polyps.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Various Clinical Entities ; Intraabdominal Right Iliac Fossa Mass ; Sensitivities ; Clinical, Radiological ; Histopathological Diagnoses. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Devi S |
| Date Deposited: | 26 Mar 2018 13:11 |
| Last Modified: | 26 Mar 2018 13:11 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/6584 |
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