An Abdominal Mass: A Case of Jekyll and Hyde?
A Sinister Abdominal Mass
Abstract
Right iliac fossa pain can often be misdiagnosed as something sinister or benevolent despite assistance with state of the art imaging techniques. This is particularly more challenging in the female gender whereby the error of managing a right iliac fossa pain may approach forty percent. A 66-year-old lady, ten years post-menopause, presented with a week history of progressively worsening right iliac fossa pain. Malignancy was suspected with a palpable abdominal mass. Computed tomography was suggestive of an abscess collection, but a needle aspirate produced brown faecal material suggestive of a diverticulitis. An exploratory appendisectomy revealed a non malignant appendicular abscess. In conclusion, when clinical and imaging assessments are inconclusive, an exploratory laparotomy for a surgical excision is warranted primarily if malignancy is suspected.
Keywords :
abscess,
caecal tumour,
giant appendix,
Abstrak
Kesakitan pada bahangian bawah dan kanan perut atau abdomen sentiasa disalah diagnosa walaupun doktor bedah kini bergantung pada teknik pengimejan yang terbaru. Ini adalah lebih mencabar terutamanya pada pesakit wanita dimana kesilapan diagnosa kesakitan pada bahagian bawah dan kanan abdomen adalah sebanyak 40%. Seorang wanita berumur 66 tahun hadir dengan sakit pada bahagian bawah dan kanan abdomen selama seminggu. Pada mulanya, semasa pemeriksaan dijalankan didapati terdapat ketumbuhan di bahagian perut yang disyaki barah. Skan Computed Tomography menunjukkan kasakitan abdomen kemungkinan berpunca daripada koleksi nanah. Namun demikian, prosedur jarum aspirasi menghasilkan bahan berunsur najis berwarna coklat yang mencadangkan penyakit diverticulitis. Pembedahan penerokaan perut dan membuang appendik mendedahkan appendik yang bernanah dan bukan barah. Kesimpulannya, apabila penilaian klinikal dan pengimejan tidak dapat disimpulkan, penerokaan laparotomi abdomen adalah wajar terutamanya jika barah disyaki.
Kata Kunci :
apendiks gergasi,
nanah,
tumor caecal,
Correspondance Address
Hardip S Gendeh. Department of Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +6-03-91456202 Fax: +6-03-91456684 E-mail: hardip88@gmail.com
