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Abstract
BACKGROUND
Right iliac fossa mass, a common condition, needs accurate arrival of diagnosis since management of each condition differs. Ultrasound is a quick, non-invasive test that has bridged the gap between palpation and direct visualization. The role of ultrasound in preoperative evaluation proves to be essential as it enables the surgeon to diagnose and treat the pathology with accuracy thereby obviating the need for further investigations. We wanted to evaluate the role of ultrasound in preoperative evaluation of right iliac fossa mass.
METHODS
A prospective study of 60 patients with clinically diagnosed RIF mass was done. Ultrasound examination by 5 and 7.5 MHz transducers was done and the clinical, radiological findings and final diagnosis were compared.
RESULTS
In our study, vast majority of the cases (50 %) presented with appendicular mass, 24 % presented with appendicular abscess, ileocaecal tuberculosis 17 %, carcinoma caecum 7%, psoas abscess 1 % and ileal lymphadenopathy 1 %. The appendicular abscess was common in 15-20 years, appendicular mass in 21-40 years, ileocaecal tuberculosis in 41-50 years, carcinoma caecum was in > 50 years, psoas abscess in 21-30 years, and ileal lymphadenopathy in 20-34 years of age. Ultrasound was able to find out the bowel thickening with target sign and pseudo kidney sign in ileo-caecal tuberculosis and carcinoma caecum with moderate specificity. Psoas abscesses were confirmed with ultrasound.
CONCLUSIONS
Appendicular pathology constituted a majority of cases. The ultrasound was able to detect appendicular abscesses with high sensitivity and specificity. It is an adjuvant diagnostic tool in cases of ileocaecal tuberculosis and carcinoma caecum. Ultrasound helped in the early assessment of the patient, enhanced the treatment effectiveness thereby reducing the morbidity and enabled early surgical intervention whenever necessary. Ultrasound, a non-invasive radiological imaging without any exposure to radiation with excellent results is an ideal first-line imaging modality in the preoperative evaluation of RIF mass.
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References
- Sabiston DC. Textbook of surgery. 16th edn. Philadelphia: W.B. Saunders Company 2001.
- Millard FC, Collins MC, Peck RJ. Ultrasound in the investigation of the right iliac fossa mass. Br J Radiol 1991;64(757):17-9.
- Foran B, Berne TV, Rosoft L. Management of the appendiceal mass. Arch Surg 1978;113(10):1144-5.
- Jordan JS, Kovalcak PJ, Schwab CW. Appendicitis with a palpable mass. Ann Surg 2012;193(2):227-9.
- Ali S, Rafique HM. Appendicular mass. Early exploration versus conservative management. Professional Med J 2010;17(2):180-4.
- Thomas DR. Conservative management of appendicular mass. Surgery 1973;73(5):677-80.
- Nagar RC, Kanwar DL. Appendix mass early appendicectomy or conservative therapy. Indian J Surg 1983;54(2):259-62.
- Broadley EL, Isaacs J. Appendiceal abscess revisited. Arch Surg 1978;113(2):130-2.
- Nitecki S, Assalia A, Schein M. Contemporary management of appendiceal mass. British Journal of Surgery 1993;80(1):18-20.
- Azad S. Essentials of surgery. 1st edn. Paras Publishers 1998.
- Joshi MJ. Conservative ileocaecal resection for diseases of the ileocaecal region. Indian J Surg 1976:255-9.
- Hurme T, Nylamo E. Conservative versus operative treatment of appendicular abscess. Ann Chir Gynaecol 1995;84(1):33-6.
- Das HS, Rathi P, Sawant P, et al. Colonic tuberculosis: Colonoscopic appearance and clinico-pathologic analysis. JAPI 2000;48(7):708-10.
References
Sabiston DC. Textbook of surgery. 16th edn. Philadelphia: W.B. Saunders Company 2001.
Millard FC, Collins MC, Peck RJ. Ultrasound in the investigation of the right iliac fossa mass. Br J Radiol 1991;64(757):17-9.
Foran B, Berne TV, Rosoft L. Management of the appendiceal mass. Arch Surg 1978;113(10):1144-5.
Jordan JS, Kovalcak PJ, Schwab CW. Appendicitis with a palpable mass. Ann Surg 2012;193(2):227-9.
Ali S, Rafique HM. Appendicular mass. Early exploration versus conservative management. Professional Med J 2010;17(2):180-4.
Thomas DR. Conservative management of appendicular mass. Surgery 1973;73(5):677-80.
Nagar RC, Kanwar DL. Appendix mass early appendicectomy or conservative therapy. Indian J Surg 1983;54(2):259-62.
Broadley EL, Isaacs J. Appendiceal abscess revisited. Arch Surg 1978;113(2):130-2.
Nitecki S, Assalia A, Schein M. Contemporary management of appendiceal mass. British Journal of Surgery 1993;80(1):18-20.
Azad S. Essentials of surgery. 1st edn. Paras Publishers 1998.
Joshi MJ. Conservative ileocaecal resection for diseases of the ileocaecal region. Indian J Surg 1976:255-9.
Hurme T, Nylamo E. Conservative versus operative treatment of appendicular abscess. Ann Chir Gynaecol 1995;84(1):33-6.
Das HS, Rathi P, Sawant P, et al. Colonic tuberculosis: Colonoscopic appearance and clinico-pathologic analysis. JAPI 2000;48(7):708-10.