From the Guidelines
The follow-up plan for a patient with right iliac fossa swelling should prioritize regular clinical assessments, imaging studies, and treatment monitoring, with a focus on the specific diagnosis and individual patient needs, as recommended by the 2020 update of the WSES Jerusalem guidelines 1. The follow-up plan may involve:
- Post-operative care with wound checks at 7-10 days, monitoring for complications like infection, and ensuring return to normal activities within 2-4 weeks for appendicitis
- 6-9 months of anti-tubercular therapy with monthly liver function tests and clinical assessments for ileocecal tuberculosis
- Long-term follow-up with gastroenterology every 3-6 months, monitoring inflammatory markers, and adjusting medications for Crohn's disease
- Regular imaging, tumor marker monitoring, and surveillance for recurrence for at least 5 years for malignancies It is essential to note that the 2020 update of the WSES Jerusalem guidelines recommends cross-sectional imaging before surgery for patients with normal investigations but non-resolving right iliac fossa pain 1, and that biochemical markers may be a promising diagnostic tool for identifying acute appendicitis, but further high-quality evidence is needed 1. In cases where the appendix appears normal during laparoscopy, the decision to remove it should be based on individual clinical scenarios, considering the risks and benefits, as there is no high-level evidence-based recommendation available 1. The use of point-of-care ultrasound (POCUS) as the first-line diagnostic tool is recommended for both adults and children, if an imaging investigation is indicated based on clinical assessment 1. Regular follow-up is crucial to detect complications, disease progression, or recurrence early and enable timely intervention to improve patient outcomes.
From the Research
Follow-up Plan for Right Iliac Fossa Swelling
The follow-up plan for a patient with right iliac fossa swelling after initial evaluation and diagnosis may involve several steps, including:
- Monitoring of symptoms and clinical findings
- Use of imaging modalities such as ultrasound or computed tomography (CT) to guide further management 2, 3
- Surgical intervention, if necessary, to treat underlying conditions such as appendicitis, neoplasia, or mesenteric fibromatosis 3, 4
- Post-operative care and follow-up to ensure normal recovery 4
Diagnostic Considerations
The differential diagnosis for right iliac fossa swelling is wide, and includes conditions such as:
- Appendicitis 3, 5
- Neoplasia 3
- Mesenteric fibromatosis 4
- Parasitic leiomyoma 6
- Non-specific abdominal pain 5
- Gynaecological causes 5
Imaging Modalities
The use of imaging modalities such as ultrasound and CT can help guide further management and treatment, with ultrasound being the imaging modality of first choice in patients presenting with a right iliac fossa mass 2, and CT being useful in patients aged over 50 years presenting with signs of peritonism in the right iliac fossa or lower abdomen 3.