Right Iliac Fossa Pain
Related Subjects:Acute Cholecystitis
|Acute Appendicitis
|Chronic Peritonitis
|Abdominal Aortic Aneurysm
|Ectopic Pregnancy
|Acute Cholangitis
|Acute Abdominal Pain
|Penetrating Abdominal Trauma
|Abdominal Masses: Clinical Approach and Considerations
|Abdominal Distension
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📖 About
- ➡️ Right Iliac Fossa (RIF) pain is a common acute surgical presentation.
Careful assessment is needed to differentiate between surgical emergencies and benign causes.
🧬 Aetiology
- ⚠️ The differential diagnosis is broad: gastrointestinal, urological, and gynaecological causes must all be considered.
🩺 Clinical Differentials
- 🔥 Appendicitis: Classically starts as peri-umbilical pain → localises to RIF; associated with anorexia, nausea, low-grade fever.
- 🦠 Mesenteric Adenitis: Often post-viral; mimics appendicitis but self-limiting.
- 🌀 Crohn's Disease: Chronic RIF pain, diarrhoea, weight loss, perianal disease.
- 💧 Urinary Tract Infection (UTI): Dysuria, urgency, suprapubic tenderness; confirmed with urine dipstick & culture.
- 🧓 Diverticulitis: More common in elderly; usually left-sided but caecal diverticulitis can mimic appendicitis.
- 🎗️ Caecal/Colonic Cancer: Insidious; may cause RIF pain, iron-deficiency anaemia, weight loss.
- ♀️ Gynaecological Causes (in females):
- 🚨 Ectopic Pregnancy: Always consider with positive pregnancy test + abdominal pain.
- 🌀 Ovarian/Tubal Pathology: Torsion, cyst rupture, pelvic inflammatory disease.
- 📅 Mittelschmerz: Mid-cycle ovulatory pain; benign and self-limiting.
🧪 Investigations
- 🩸 Blood Tests: FBC (WCC, Hb), CRP, U&E, LFTs, amylase; β-hCG in women of childbearing age.
- 🧫 Urine Tests: Dipstick ± culture to rule out UTI.
- 🖼️ Imaging:
- 🔍 Ultrasound: First-line in young patients and females (appendix, ovarian pathology).
- 💻 CT Abdomen/Pelvis: Gold standard in adults when diagnosis uncertain.
- 📸 AXR/CXR: Limited role, may detect perforation (free air) or obstruction.
💊 Management
- 🏥 Initial Stabilisation: ABCs, IV access, fluids, nil by mouth, catheterisation if required.
- 💉 Analgesia: Opiates or NSAIDs (safe once diagnosis is being pursued).
- 🧪 Antibiotics: Broad-spectrum IV cover if sepsis/appendicitis suspected.
- 🔪 Surgical:
- Appendicectomy = gold standard for confirmed appendicitis.
- Diagnostic laparoscopy useful in equivocal cases, particularly in females.
📚 References
- Royal College of Surgeons: Guidelines for acute abdominal pain.
- Oxford Handbook of Clinical Surgery – Acute Abdomen section.
