Right iliac fossa mass: Differential diagnosis

Abstract text (incl. references and figure legends)

Case history: A 33 year-old female patient, presented to our emergency department with severe pain in the right iliac fossa (RIF). She was diagnosed by abdominal ultrasound, with a twisted calcificated teratoma 8,5cm sized. A laparoscopy was performed and it showed a hemorrhagic cyst rupture with hemoperitoneum, with no appendix exploration. Ovarian cystectomy was performed and patient was discharged. 3 days later, she came again to the emergency department because of persistent RIF pain. Clinical findings was RIF tenderness to palpation. Laboratory results showed leukocytosis and neutrophilia, PCR 16,41 mg/dl. CT scan showed a pelvic calcification mass 7 cm sized with inflammatory changes. Therapy: A new exploratory laparoscopy was performed. It showed a cystic mass 7 cm sized in the appendicular base. We decided to convert to open surgery and perform an ileocecal resection with ileocolic anastomosis. She has normal post-operative course and she was discharge on the 4th postoperative day. Comments: Acute appendicitis is the most common general surgical emergencies. Despite being so common, RIF continues to pose diagnostic challenges. The probability of the pathology underlying RIF pain not being appendicitis is proportionally higher in female patients, so a differential diagnosis between gynecological diseases is mandatory. RIF pain in female patients of reproductive age, the initial diagnosis approach includes ectopic pregnancy and ovarian pathology. In equivocal cases, a pelvic examination by gyneacologists can differentiate alternative pathology.When signs and symptoms are not suggestive, we can choose a procedure which is simultaneously diagnostic and therapeutic. An early exploratory laparoscopy improves diagnosis in female patients with an equivocal diagnosis and we should visualize gynecological structures and appendix. If there's no other diagnosis suspicion, appendicectomy must be performed. Refferences:0.1111/jpc.13737, 10.1016/j.ciresp.2019.02.006

Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)

No