➡️ 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.

The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms.

Right Iliac Fossa Pain

📖 About

🧬 Aetiology

🩺 Clinical Differentials

🧪 Investigations

💊 Management

📚 References

Categories