Right Iliac Fossa Mass: Histopathology And Clinical Correlates With Special Reference To Preoperative Diagnostic Imaging-A Prospective Observational Open Label Clinical Study Among Adult Population In A Tertiary Care Center In Eastern India

Abstract

Introduction: Mass lesions in the right iliac fossa (RIF) are a pretty common entity faced by the surgeons and surgical pathologists. The etiologic variation ranges from inflammatory, infective to neoplastic proportions. Concomitant comorbidities in the adult subset of patients pose a considerable diagnostic and management challenge. Not infrequently, exploratory laparotomy based on traditional clinical diagnosis land up in misadventure, given the complexities in presentation, chances of postoperative complications and recurrence. Some entities respond to conservative management, while others need emergency or elective surgery. Therefore, preoperative investigations play a crucial role in decision making.
Objective: The study was conducted to acquire an in-depth knowledge on varied presentations and to evaluate preoperative investigative protocols in the light of operative findings and definitive postoperative diagnosis by means of histopathological examination (HPE).
Methods: This study was undertaken with one hundred adult patients of RIF mass presenting in the surgical outpatient and emergency units in a tertiary care center after approval of the institutional ethics committee (IEC) and written informed consent, excluding the pediatric population, female patients with gynecological pathology, RIF mass due to extra-abdominal pathology and terminally ill patients. Demographic variables, clinical parameters, preoperative diagnostic imaging, operative record and HPE findings were studied and correlated with appropriate statistical principles.
Results: Among the study participants, 70% were male with an age range of 21-70 years. Commonest presentation was appendicular lump (62%), followed by carcinoma of cecum and ascending colon (16%). Ultrasound (USG) findings correlated with that of contrast enhanced computed tomography (CECT) scan of the abdomen. All surgical specimens were subjected to HPE. A significance level of 0.05 was chosen for the calculation of P-value.
Conclusion: The study showed significant association of clinical and radiological profiles with histopathological findings, where definitive surgical management could be given.