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An uncommon right iliac fossa mass in an older woman

A 74 year old woman was referred to the general surgery clinic after she found a lump in her lower abdomen, which she had noticed 4-5 weeks previously. She also reported a feeling of not completely emptying her bowels, and reduced frequency of bowel opening. She had noticed no blood or mucus in the toilet bowl, and had not had abdominal pain, lower urinary tract symptoms, or vaginal discharge. She had lost two stone (12.7 kg) in weight over a few months, but she attributed this to a recent diagnosis of diabetes mellitus. Her surgical history was a total abdominal hysterectomy and bilateral salpingo-oophorectomy in 1996 for menorrhagia. On examination, she had a large non-tender soft swelling in the right iliac fossa but no evidence of inguinal, femoral, or pfannenstiel incisional hernia. Blood tests were unremarkable, and a colonoscopy identified only mild diverticular disease. A computed tomography (CT) scan of her abdomen and pelvis was taken (fig 1⇓).



Fig 1  Sagittal slice of a computed tomogram …