R I G H T I L I AC F O S SA
M A S S
By,
Prof R.A.Pandyaraj,
MS, FICS,FAIS,FMAS(Laproscopy).
Head of surgery department,
Govt. Royapettah Hospital.





•
•
•
•
•
•
•

•
•
•
•
•
•

PAIN
• Dullaching
• Colicky
• Continuous / intermittent

PARIETAL
INTRA
ABDOMINAL
SOLID CYSTIC

PARIETAL
INTRA
ABDOMINAL
1. LIPOMA
2. DESMOID TUMOR
3. PYOGENIC ABSCESS
4. INTRA ABDOMINAL ABSCESS
BURROWING THROUGH
1. ILIAC ABSCESS
2. APPENDICULAR ABSCESS

PARIETAL
INTRA
ABDOMINAL
INTRA PERITONEAL

PARIETAL
INTRA
ABDOMINAL
INTRA PERITONEAL RETRO PERITONEAL

SOLID
• APPENDICULAR MASS
• CARCINOMA CAECUM
• ILEO-CAECAL TUBERCULOSIS
• EXTERNAL ILLAC
LYMPHADENITS
• RETRO PERITONEAL
SARCOMA
• CROHN’S
• UNASCENDED KIDNEY
• ACTINOMYCOSIS
CYSTIC
• APPENDICULAR ABSCESS
• PSOAS ABSCESS
• RT.OVARIAN CYST
• ILIAC ARTERY ANEURSYM

AGE
APPENDICULAR
MASS
ANY AGE,COMMON
IN YOUNGER AGE
ILEO CAECAL TB CA.CAECUM
YOUNG& MIDDLE AGE MIDDLE &
OLDER AGE
PAIN
FEVER
VOMITING
SHORT DURATION,
>3 DAYS,MIGRATING
INITIALLY
HIGH GRADE
++
Colicky
LOW GRADE
RECURRENT
+++,
IF OBSTRUCTED
ALTERED
BOWEL
HABITUS
DIARRHOEA ALTERED
WITH CONSTIPATION
NO PAIN, MAY
BE IN LATE
STAGE
Absent
++
IF
OBSTRUCTED
+

APPENDICULARMASS ILEO-CAECAL TB CA.CAECUM
TENDER
SOFT TO FIRM
ILL DEFINED BORDERS
IRREGULAR & FIXED
TYMPANIC NOTE
NON-TENDER
FIRM TO HARD
HIGHLY PLACED
DOUGHY ABDOMEN
NON-TENDER
HARD
FIXED
ASCITES
HEPATOMEGALY

• Blood HB , TC,DC,ESR
• RFT
• X-Ray – Chest,Abdomen Erect
• Barium Enema
• USG Abdomen
• CT Scan Abdomen

APPENDICULAR
MASS
PLAIN XRAY LOCALISED ILEUS
ILEO-CAECAL TB CA.CAECUM
BARIUM
STUDY
USG
NOT INDICATED
MIXED ECHOGENIC
LESION
MULTIPLE
AIR-FLUID LEVELS
CALCIFIED
TBNODES
PULLED UP
CAECUM,
NARROWED
TERMINAL ILEUM
WIDENING OF
ILEO-CAECAL
ANGLE
DILATED ILEUM
THICKENED CAECUM
_
IRREGULAR
FILLING DEFECT,
APPLE CORE SIGN
SOLID CAECAL
MASS
HEPATOMEGALY
,ASCITIS

APPENDICULAR MASS
This is caused by inflammation and swelling of the appendix, caecum, omentum and distal part of the terminal ileum
• Treat conservatively with bowel rest, antibiotics, analgesics and fluids
• Consider interval appendicectomy if symptoms recur

APPENDICULAR MASS
Approach A OSCHNER REGIMEN
Initial conservative treatment followed by interval appendicectomy six to eight weeks later
Approach B
Immediate appendicectomy following inflammatory mass resolution
Approach C
An entirely conservative approach without interval appendicectomy in patients with appendiceal mass

APPENDICULAR MUCOCELE
• Appendicular mucocele is a rare lesion (0.2 ‐ 0.3% of surgical appendicectomy specimens)
• It is a descriptive term denoting an obstructive dilatation of the appendicular lumen by mucinous secretions

MUCINOUS CYSTADENOMA AND
CYSTADENOCARCINOMA
MUCINOUS CYSTADENOMA AND CYSTADENOCARCINOMA
ACCOUNT FOR 60 ‐ 70% OF ALL MUCOCELES
LESS COMMON CAUSES:
 RETENTION CYST
 MUCOSAL HYPERPLASIA
 CARCINOID
 APPENDICOLITH
 ENDOMETRIOSIS
 ADHESIONS
 VOLVULUS

MUCINOUS CYSTADENOMA AND
CYSTADENOCARCINOMA
‐ High Correlation Of Synchronous Or Metachronous Colorectal
Adenomas And Carcinomas (Up To 20%)
‐ Association With Mucin‐secreting Tumors Of The Ovary
‐ Pseudomyxoma Peritonei (Avoid Iatrogenic Rupture Of The
Mucocele)
TREATMENT
• Appendicectomy Is Used For Simple Mucocele Or For cystadenoma
• Right Hemi‐colectomy Is Recommended For Cystadenocarcinoma

• Cough with expectorant,evening raise of temperature,haemoptysis,
• Attitude of flexion,spine tenderness,gibbus
• Cross fluctuation
• No line of separation/space between mass&iliac spine

• INFLAMMATORY DISEASE INVOLVING ILEUM , CAECUM
, COLON
• PTS.PRESENT WITH DIARRHOEA , FEVER , MULTIPLE
FISTULA (PERIANAL) , WITH SIGNS OF INTESTINAL
OBSTRUCTION
• COBBLESTONE APPEARANCE , PSEUDOPOLYPS, SKIP
LESIONS
• STRING SIGN OF KANTOR ( NARROWING OF TERMINAL
ILEUM )

COBBLESTONE APPEARANCE

ILEO-CACEAL TB
ABDOMINAL
TUBERCULOSIS
INTESTINAL
ULCERATIVE HYPERPLASTIC STRICTOROUS MIXED PERITONEUM
EXTRA
INTESTINAL
MESENTRY
SOLID
ORGANS
GENITO-
URINARY
SYSTEM
ACUTE CHRONIC

ABDOMINAL TUBERCULOSIS

ABDOMINAL TUBERCULOSIS

ILEO-CAECAL TB
ILEO CAECAL REGION IS MORE COMMONLY INVOLVED ???????
RICH LYMPHATICS IN PEYER’S PATCHES
ALKALINE MEDIUM
ILEOCECAL VALVE PRECIPITATES STASIS
TERMINAL ILEUM IS MAXIMUM AREA OF
RESORPTION

• CATEGORY I – ATT
• IN CASE OF COMPLICATIONS
– LIMITED RESSECTION
– RIGHT HEMICHOLECTOMY

• CALCIFIED TB
MESENTRIC NODES

MESENTERIC-CYST

CARCINOMA CAECUM

• APPLE CORE
APPEARANCE IN
CA.CAECUM

INTUSSUSCEPTION

INTUSSUSCEPTION

COMPLICATIONS

• Menstrual h/o; menorrhagia,polymenorrhagia,dysmenorrhea
• Leucorrhea,dyspareunia,
• Lower border not felt,
• Per vaginal; rt.fornix tenderness,