RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE,

KARNATAKA
ANNEXURE – II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. Name of the Candidate and Dr. PRADEEP N.

Address S/O R. NATESH KUMAR
(in block letters) # 550/A-5,
K.R. ROAD,
DAVANGERE – 577 001.
2. Name of the Institution J.J.M. MEDICAL COLLEGE,
DAVANGERE-577004.
3. Course of Study and Subject POST GRADUATE - MEDICAL
M.S. IN GENERAL SURGERY
4. Date of admission to Course 30.05.2008
5. Title of the Topic “CLINICAL STUDY OF MASS IN THE
RIGHT ILIAC FOSSA”

6. Brief resume of the intended work

6.1 Need for the study:
Mass in the RIF is one of the commonest problem faced in surgical practice.
Mass may be intraabdominal or parietal in origin. Mass may develop in
connection with the structures which are normally present in this region or may
originate from organs lying in other regions and abnormally invade this region.1

The structures which are normally present in this region are 1) appendix 2)
caecum 3) terminal part of the ileum 4) lymph nodes 5) iliac arteries 6)
retroperitoneal connective tissue 7) iliopsoas sheath 8) ilium.1

Appendicular lump is the commonest swelling in the right iliac region. The
lump may be either an appendicular mass or an appendicular abscess. Important
differential diagnosis is between appendicular mass, abscess, carcinomia caecum
and intestinal tuberculosis.1

1
 Intestinal tuberculosis is seen more common in people of poor
socioeconomic status. There will be early involvement of regional lymph nodes
which become matted along with the involved terminal part of ileum and caecum
to produce the lump.1

Caecal carcinoma is more common in high socio-economic people who use

less fibrous and purified diet. Carcinoma of caecum is curable when diagnosed
early and treated.2

Diagnosis of abdominal mass mainly depends on clinical examination and

investigations. The patients are subjected to pathological and radiological
investigations.

The main intention of this study, is to know the incidence, varying modes of
presentation, different modalities of diagnosis, treatment and prognosis in our set
up and to identify factors which can help in better management of these cases thus
helping to improve the prognosis and management care.

6.2 Review of Literature :

The appendix was not identified as an organ capable of causing disease until
the 19th century. Initial surgical therapy for appendicitis was primarily designed to
drain right lower quadrant abscesses that occurred secondary to appendical
perforation. Soon afterwards Charles McBurney, Prof of Surgery, USA described
the clinical manifestation of appendicitis including the point of maximum
tenderness in RIF that since bears his name.3

Patients with atypical manifestation related to right lower abdominal

quadrant should be thoroughly investigated with an open mind.4

The patients presenting with a RIF mass are a diagnostic problem and
ultrasound is the imaging modality of first choice in patients presenting with a RIF
mass.5

2
 A combined approach with ultrasonography and CT scan is particularly
helpful as an area of interest can be delineated.6

Most of the patients with caecal carcinoma presented as a mass in RIF and
only some patients as intestinal obstruction right hemicolectomy and primary
ileotransverse anastomosis was the standard surgical procedure adopted. 2

Appendiceal mass should no longer be regarded as an indication for interval

appendicetomy.7

6.3 Objectives of the study:

1. To Study various diseases which can present with mass in the right iliac fossa.
2. To study the modes of investigations available to diagnose various types of
mass in the right iliac fossa.
3. To study the various modes of management including complications.

7. Materials and methods:

7.1 Source of data:
The study will be conducted on patients with mass in the right iliac fossa
admitted C.G. Hospital and Bapuji Hospital, attached to J.J.M. Medical College,
Davangere between June 2008 to June 2010.

7.2 Method of collection of data :( including sampling procedure if any)

- Patient provisionally diagnosed to have mass in the right iliac
fossa by clinical evaluation will be included in this prospective study.
- A total minimum number of 30 patients will be studied.
- The period of study is from June 2008 to June 2010.
- Direct interview with patient and obtaining a detailed history.
- Through clinical examination.
- Appropriate investigations performed over the patients.
- A pretested structural proforma will be used to collect relevant
information for each individual patient selected.
- Cases will be selected consequently with following inclusion
and exclusion criteria.

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Inclusion criteria :
All the cases admitted to C.G and Bapuji Hospital with the provisional
diagnosis as right iliac fossa mass.

Exclusion criteria :
Female patients with pathologies related to uterus and its adnexa were not
included in this study. Similarly mass arising from parietal (anterior abdominal
wall), vascular lesions, distended gall bladder, unasended kidney.

7.3 Does the study require any investigations or interventions to be conducted

on patients or other humans or animals? If so, please describe briefly:
Routine investigations
Relevant :
- USG abdomen
- Barium follow through and enema
- Chest x-ray
- CT scan

7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Yes

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8. List Of References:

1) Das S. Examination of abdominal lump, Chapter 35 In: A manual on clinical

surgery. 5th edn. 2007;p. 396.
2) Amin MA, Khan MA, Ayub M, Mohamood M, Ashraf M, Choudhry AR.
Delay in the diagnosis and prognosis of caecal carcinoma – a study of 20 cases.
J Ayub Med Coll Abbottabad 2001 Apr-Jun;13(2):28-31.
3) Tafte BM, Berges DH. The Appendix, Chapter 29. In: Schwartz principles of
surgery. 8th Edn., McGraw Hill Inc., USA, Vol.2;p.1119.
4) Ahmed K, Hoque R, Tawil EL, Khan MS, George ML. Adenocarcinoma of
appendix presenting as bilateral ureteric obstruction. World J Surg Oncol 2008
Feb 21;6:23.
5) Millard FC, Collins MC, Peck RJ. Ultrasound in the investigation of the right
iliac fossa mass. Br J Radiol 1991;64:Issue 757:17-19.
6) McLaughlin SJ, Gray JG, Braithwaith M. Diagnosis of right iliac fossa mass
by computed tomography. Br J Radiol 1986 June;59:623-624.
7) Adalla SA. Appendicular mass. Internal appendicetomy should not be the
rule. Br J Clin Pract 1996 Apr-May;50(3):168-9.
8) Mukthar AU. Case report in cent. Afr J Med 2005 Feb;46(2):45-5.
9) Higgins MJ, Walsh M, Kennedy SM, Hyland JM, McDermott E, O’Higgins
NJ. Granulomatous appendicitis. Dig Surg 2001;18(3):245-8.
10) Karaca F, Attintoprak Z, Karkiner A, Temir G, Mir E. The management of
appendiceal mass in children, is interval appendicectomy necessary? Surg
Today 2001;31(8);675-7.
11) Bromberg SH, Farocid S, de-Castro FF, Morrone N, De-Godoy AC, Franca
Lc. Isolated ileocaecal tuberculosis simulating malignant neoplasia and crohn’s
disease. Rev Assoc Med Bros 2001 Apr-Jun;47(2):125-80.

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9. Signature of the Candidate
10. Remarks of the Guide
11. Name & Designation of
(in block letters)
11.1 Guide
11.2 Signature
11.3 Head of the Department
11.6 Signature
12. 12.1 Remarks of the Chairman
& The Principal
12. 2 Signature
Mass in the right ileac fossa is one of the
commonest conditions encountered in surgical
practice. Hence there is a need to study about
the incidence, different modes of presentation,
different modalities of investigation,
treatment and prognosis of this condition.
Dr. J.T. BASAVARAJ M.S. GEN. SURG.
PROFESSOR,
DEPARTMENT OF SURGERY,
J.J.M. MEDICAL COLLEGE,
DAVANGERE – 577 004.
Dr. B. PRADEEP M.S.,
PROFESSOR AND H.O.D.,
DEPARTMENT OF SURGERY,
J.J.M. MEDICAL COLLEGE,
DAVANGERE – 577 004.