1. RIGHT ILIAC FOSSA MASS-DDS & INVESTIGATIONSBY
ZIYANA LIYAKATH
2002 BATCH 10

2. ILIAC FOSSA REGION-ANATOMYY
ABOVE BY ILIAC CREST;BELOW BY ARCUATE LINE;ANT AND POST BY BORDERS 10

3. TOPOGRAPHY OF RIF 10

4. Swellings in RIF PARIETAL
rare except iliac abscess/appendicular abscess burrow through anterior abdominal wall & may become parietal
INTRA ABDOMINAL
Two types
Structures normally present in the site
Structures abnormally invade region 10

5. NORMALLY PRESENT APPENDIX CAECUM TERMINAL PART OF ILEUM LYMPH NODES
ILIAC ARTERIES
RETROPERITONEAL CONNECTIVE TISSUE
Gross 10

6. ILIOPSOAS SHEATH
ILIUM 10

7. ABNORMALLY INVADE RENAL SWELLING GALL BLADDER SWELLING
UTERINE SWELLING
URINARY VESICAL
UNASCENDED TESTIS
PELVIC ABSCESS 10

8. APPENDIX 10

9. ANATOMY Average length:7.5-10 c.m
Position->retrocaecal(44%),pelvic(21%),subcaecal(1.5%),postileal(.5%),paracaecal(2%),preileal(1%)
Histology->mucosa,sub mucosa,muscularis propria,serosa
Mesentry->meso appendix
Blood supply->appendicular artery,acessory appendicular 10

10. Position of appendix 10

11. APPENDICULAR MASS Third day or earlier after attack of appendicitis
At the position of appendix
O/E->irregular firm tender & fixed mass
Rigidity of abdominal musculature
Tympanitic on percussion
CONSTITUENTS
Inflamed appendix
Greater omentum
Oedematous caecal wall
.coils of small intestine 10

12. APPENDICULAR ABSCESS Failure of resolution of appendix mass
Continued spiking pyrexia 10

13. RARE
MUCOCELE
When proximal end of lumen slowly becomes completely occluded by fibrotic stricture & retained sterile secretions ,appendix enlarged greatly & sometimes contains several milli litres of mucus
When infection supervenes empyema develops 10

14. Mucocele appendix
PATHOLOGICAL SPECIMEN 10

15. NEOPLASMS CARCINOID TUMOUR[ARGENTAFFINOMA]
Arise from argentaffin tissue[kulchitsky cells of crypts of lieberkuhn],most commonly in vermiform appendix
10 times more common
Frequently distal 3rd
Feels hard 10

16. Carcinoid tumour 10

17. CARCINOMA CAECUM Patient above 40 Hard fixed lump
May not be any change in bowl habit if present alternate constipation & diarrhoea
Anemia,anorexia,weight loss 10

18. AMOEBIC CAECAL MASS Entamoeba Histolytica
Tenderness on deep palpation over caecum & sigmoid
Entamoeba histolytica 10

19. ACTINOMYCOSIS Hard & fixed mass
Multiple sinuses seen discharging sulphur granules
Discoloration of affected skin 10

20. TERMINAL ILEUM IMPACTION OF ROUND WORMS Lower part of ileum
History of passing worm with stools/vomitus 10

21. CROHN’S DISEASE CLINICAL FEATURES INFLAMATORY STAGE Tender mass Fever
Anemia
Diarrhoea
COLITIS STAGE 10

22. Small intestinal obstruction
Diarrhoea,fever,anemia,loss of weight,occult blood & mucus present in stool
Steatorrhoea
Fissure in ano
Perianal abcess
Anal fistula
STENOTIC STAGE
Small intestinal obstruction 10

23. FISTULA
External/internal 10

24. CROHN’S DISEASE 10

25. ILEOCAECAL REGION HYPERPLASTIC ILEOCAECAL TB
Injection of mycobacterium TB.Infection starts in lymphoid follicles &then spreads to submucous & subserous planes
Intestinal wall thickened,lumen narrowed
Matted lymphnodes+terminal part of ileum & caecum involvement produced lump 10

26. Gross specimen of ileum showing multiple hypertrophied tubercular pseudopolyps and cut part of appendix
Gross specimen of ileum showing multiple hypertrophied tubercular pseudopolyps and cut part of appendix
Gross specimen of ileum showing multiple hypertrophied tubercular pseudopolyps and cut part of appendix
Gross specimen of ileum showing multiple hypertrophied tubercular pseudopolyps and cut part of appendix
Gross specimen of ileum showing multiple hypertrophied tubercular pseudopolyps and cut part of appendix
Gross specimen of ileum showing multiple hypertrophied tubercular pseudopolyps and cut part of appendix
Gross specimen of ileum showing multiple hypertrophied tubercular pseudopolyps and cut part of appendix 10

27. 1.Recurrent attacks of abdominal pain with diarrhoea
COMPLAINTS
1.Recurrent attacks of abdominal pain with diarrhoea
2.Blind loop syndrome
3.lump
4.general 10

28. GIBBUS OF SPINE 10

29. LYMPH NODES Enlargment of iliac group of lymphnodes A.FILARIAL
Periodic attacks of fever with simultaneous tenderness & swelling of nodes 10

30. B.TUBERCULOUS LYMPH NODE GENERAL FEATURES Matted lymph nodes10

31. Rapid enlargment of nodes Young subject D.SECONDARY CARCINOMA
C.LYMPHOSARCOMA
Rapid enlargment of nodes
Young subject
D.SECONDARY CARCINOMA
Other evidence of primary ca
Usually old 10

32. ANEURYSM OF ILIAC ARTERIES
RARE
PATHOLOGICAL SPECIMEN 10

33. ILIOPSOAS SHEATH ILIAC ABSCESS
Infection of haematoma in iliacus muscle
Pain,tenderness restricted to region
Clear space btw abscess&ilium 10

34. TENDER POINT OF ILIACUS10

35. PSOAS ABSCESS
Down the thoracolumbar vertebra to pelvis&crosses inguinal ligament to thigh
Cross fluctuation present 10

36. ABSCESS IN THE THIGH 10

37. ILIUM
Bony swelling 10

38. ABNORMALLY INVADING 1.KIDNEY A.PELVIC KIDNEY
The first rudiment appear in pelvis
With development ascend to final position
Due to unknown reasons kidney fail; to ascend & remains permanently in pelvis/right iliac fossa
B.DROPPED/MOVABLE KIDNEY
Extremely rare 10

39. GALL BLADDER SWELLING
Hugely distended gall bladder with enlarged liver descend as low as right iliac fossa 10

40. UTERINE & IT’S APPENDAGE10

41. Menstrual irregularities p/v can confirm clinically
h/o vaginal discharge
Menstrual irregularities
p/v can confirm clinically
A.tubo-ovarian mass
B.pyosalpinx
C,.cyst & abscess of broad ligament
D.fibroid of uterus
E.ovarian cyst 10

42. UNDESCENDED TESTIS Develops in lumbar region
As foetus grows,testis descends through inguinal canal into scrotum
Fails to descend
Commonest-superficial ing pouch 10

43. PELVIC ABSCESS Most common presentation-spiking pyrexia
Pelvic pressure/discomfort associated with loose stool,tenesmus
P/R->Boggy tender mass in pelvis anterior to rectum 10

44. INVESTIGATION 10

45. A.ANEMIA-malignancy,tuberculosis,crohn’s disease
1.ROUTINE BLOOD
A.ANEMIA-malignancy,tuberculosis,crohn’s disease
B.ESR-malignancy,tuberculosis,crohn’s disease 10

46. C.POLYMORPHONUCLEAR LEUCOCYTOSIS
D.EOSINOPHILIA
E.MICROFILARIAE 10

47. MICROFILARIAE 10

48. EOSINOPPHILIA 10

49. 2.URINE
UTI
RBCs
3.STOOL
Occult blood
microscopy 10

50. Psoas abscess,ileocaecal T.B,lymphnode AFB STAIN C & S
4.TUBERCULOUS ETIOLOGY
Psoas abscess,ileocaecal T.B,lymphnode
AFB STAIN
C & S
LUMBAR X-RAY,DORSAL SPINE X-RAY 10

51. AFB SMEAR 10

52. CHEST&DORSAL SPINE 10

53. 5.ULTRASOUND- 10

54. TRANSVAGINAL 10

55. A.obstructive appendicitis-faecolith as filling defect
6.BARIUM ENEMA
A.obstructive appendicitis-faecolith as filling defect
B.Ca caecum-filling defect
C.crohn’s disease-string of kantor,caecum in normal position not elevated
D.ileocaecal TB-long narrow constricted terminal ileum & ascending colon with caecum higher up 10

56. CROHN’S DISEASE CROHN’S DISEASE -STRING OF KANTOR SIGN
STRING OF KANTOR SIGN IN CROHN’S DISEASE 10

57. APPENDICULOLITH
OBSTRUCTIVE APPENDICITIS 10

58. ILEOCAECAL TUBERCULOSIS10

59. MUCOUS SECRETING ADENOCARCINOMA CAECUM10

60. ILIOPSOAS ABSCESS
ILIOPSOAS ABSCESS 10

61. 7.CTSCAN-if neoplasm suspected
8.COLONOSCOPY->diagnostic & therapeutic
9.IVP->to rule out kidney problem
10.pelvic x-ray-ilium mass 10

62. CT-APPENDICULAR MASS 10

63. CT-ILEOCAECAL TUBERCULOSIS
Ct scan-ileo caecal tuberculosis 10

64. CT-ACTINOMYCOSIS
CT-ACTINOMYCOSIS 10

65. CT-CARCINOMA CAECUM 10

66. PELVIC KIDNEY-CT 10

67. IVP-PELVIC KIDNEY 10

68. PELVIC X-RAY ILIUM MASS10

69. ENDOSCOPY-ILEOCAECAL TUBERCULOSIS
ENDOSCOPY IN ILEOCAECAL TUBERCULOSIS 10

70. ENDOSCOPY-CROHN’S DISEASE
Endoscopy in crohn’s disease 10

71. THANK YOU 10