Diagnostic Challenges in Right Iliac Fossa Mass Caused by a Fish Bone

Ahmad Ibrahim Yahaya,1 Ismail Burud,2 Jasiah Zakariaa1

1 Department of General Surgery, Hospital Tuanku Ja’afar, Jalan Rasah, 70300 Seremban, Negeri Sembilan, Malaysia

2 Department of Surgery, International Medical University, Clinical Campus, 70300 Seremban, Negeri Sembilan, Malaysia

Correspondence to: Dr. Ahmad Ibrahim Yahaya, Email: aiyqosim@yahoo.com

Received: 07 December 2019; Revised: 01 June 2020; Accepted: 05 June 2020; Available online: 22 June 2020



Right iliac fossa (RIF) mass is a common condition seen by surgeons. Despite advances in diagnostic modalities, it remains a diagnostic and therapeutic challenge, hence many authors describe RIF mass as temple of surprises. We report a challenging case of a 35-year-old man who presented with a tender RIF mass. Abdominal ultrasonography (USG) and computed tomography (CT) scan abdomen were done and he was treated non-surgically. His symptoms recurred after one month and a CT scan abdomen was repeated which revealed a suspicious foreign body within the appendicular mass. Laparotomy was performed which showed a macerated appendix with a 4-cm long fish bone within. The role of diagnostic tools in managing RIF mass and the treatment modality of appendicular mass are discussed. In managing RIF mass, a surgeon must be aware of the various differential diagnoses, but common diagnosis should always be entertained. Multi-modal diagnostic tools must be considered, including serial imaging in different planes.


Keywords: Appendicitis, Right iliac fossa mass, Fish bone

Ann Afr Surg. 2021; 18(1):59–62

DOI: http://dx.doi.org/10.4314/aas.v18i1.11

Conflicts of Interest: None

Funding: None

© 2021 Author. This work is licensed under the Creative Commons Attribution 4.0 International License.


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