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subject: Abdominal swellings (localized): lower abdominal [print this page]

Abdominal swellings (localized): lower abdominal

KEY POINTS

Retroperitoneal mass: no movement with respiration, difficult to delineate, resonant to percussion.

Bowel masses: often mobile, may be well defined.

Pelvic mass: difficult to get below', bimanually palpable on PR/PV

examination.

Sigmoid colon

Diverticular mass: tender, ill defined, rubbery hard, non-mobile.

Paracolic abscess: acutely tender, ill defined, ?fluctuant, systemic

upset.

Carcinoma: hard, craggy, non-tender unless perforated, immobile,

associated with altered bowel habit/obstructive symptoms.

Faeces: firm, indentable/malleable', mobile with colon.

Normal: only in a thin person, non-tender, chord like.

Caecum/ascending colon

Appendix mass/abscess: acutely tender, ill defined, fluctuant,

systemic upset.

Carcinoma: hard, craggy, non-tender unless perforated, immobile,

associated with anaemia/weight loss and anergia.

Terminal ileum

Crohn's mass: tender, ill defined, rubbery hard, non-mobile.

Tuberculous mass: mildly tender, ill defined, firm, associated with cutaneous sinuses, systemic TB.

Ovary/fallopian tube

Cyst: may be massive, usually mobile, ?bimanually palpable on PV examination.

Neoplasm.

Ectopic pregnancy: very tender, associated with PV bleeding/ intra-abdominal bleeding and collapse.

Salpingo-oophoritis: very tender, bimanually palpable, associated with PV discharge.

Bladder

Generally: midline swelling, extends up towards umbilicus, dull to percussion, non-mobile, cannot get below' it.

Retention of urine: stony dull to percussion, associated with desire to pass urine, disappears on voiding/catheterization.

Transitional cell carcinoma: hard, irregular, fixed, may be associated with dysuria, haematuria and desire to pass urine on examination.

Uterus

Pregnancy: smooth, regular, fetal heart sounds heard/ movements!

Fibromyoma: usually smooth, may be pedunculated and mobile, non-tender, associated menorrhagia.

Uterine carcinoma: firm uterus, may be tender, irregular only if tumour is extrauterine, associated PV bloody discharge.

Rectum

Carcinoma: firm, irregular, non-tender, relatively immobile, associated alteration in bowel habit/PR bleeding.

Urachus (rare)

Cyst: small swelling in midline, ?associated umbilical discharge.

Other

Pelvic kidney: smooth, regular, non-tender, non-mobile.

KEY INVESTIGATIONS

FBC: anaemiabtumours.

WCC: lymphomas, Crohn's disease, appendicitis/diverticulitis.

LFTs: liver lesions.

Ultrasound: ovarian lesions, appendix/diverticular mass or abscess, Crohn's mass, pelvic kidney, ovarian lesions, pregnancy, uterine lesions, bladder tumours.

CT scan: retroperitoneal/mesenteric cysts, omental deposits, appendix/diverticular mass or abscess, Crohn's mass. Allows guided drainage of abscesses and biopsy of some tumours.

Colonoscopy: colonic tumours, diverticular disease.

Small bowel enema: small intestinal tumours, ileal Crohn's disease.

Barium enema: diverticular disease, colonic tumours.

MSU: infected urinary retention.

-HCG: pregnancy.

Source: Surgery At a Glance

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