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A Prospective Study of the Lumps in the Right Hypochondrium

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A Prospective Study of the Lumps in the Right Hypochondrium International Surgery Journal Jayakar SR et al. Int Surg J. 2020 Mar;7(3):757-763 http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 DOI: http://dx.doi.org/10.18203/2349-2902.isj20200818 Original Research Article A prospective study of the lumps in the right hypochondrium Sudhir R. Jayakar, Prashant V. Male*, Maitreyee M. Save, Varun S. Shetty Department of General Surgery, Dr. D. Y. Patil Hospital and Research Centre, Pimpri, Pune, Maharashtra, India Received: 16 December 2019 Revised: 09 February 2020 Accepted: 12 February 2020 *Correspondence: Dr. Prashant V. Male, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: The abdominal cavity can harbour a varied spectrum of diseases. Abdominal lumps are one of the commonest disorders in this region. The clinical presentation, diagnosis, minimal investigations and optimum treatment of the lumps in the right hypochondrium were studied in detail in present study. Methods: The prospective observational study was carried out for 24 months. 60 consecutive patients who satisfied the inclusion criteria were taken up for the study. Calculation and analysis of data was done by using MS Excel. Results: The lumps in the right hypochondrium were most common in the 31-40 years age group in the present study. Majority of the lumps were found to be intraperitoneal (65%), of which 45% were neoplastic in nature. 68.3% as compared to 31.7% of lumps had an organ of origin which was not anatomically situated in the right hypochondrium viz. from right kidney and right adrenal. Hepatic lumps were found to be the commonest (35%), of which 14.3% were malignant tumors. Gall bladder carcinoma was more common in 40-60 years with female preponderance. Only 26.7% patients presented with the complaint of lump in abdomen. The commonest complaint was pain in the abdomen followed by vomiting. In 88.3% cases surgery was undertaken for curative or palliative purposes. Conclusions: Of all the lumps in the right hypochondrium, intraperitoneal lumps were more common with abdominal pain as commonest presenting symptom. The commonest lumps were found to be hepatic lumps. Incidence of Neoplastic masses was more than infections and infestations. Keywords: Aetiological classification of lumps, Anatomical origin of lumps, Intra-peritoneal lumps, Right hypochondrium lumps INTRODUCTION may occur in connection with the many organs. In case of liver it can give rise to congenital Riedel's lobe, amoebic The abdominal cavity can harbor a varied spectrum of hepatitis and abscess in which ultrasonography is a highly 1 disease, putting many able surgeons into a quandary. reliable investigation. Also includes suppurative Various disorders can present as abdominal complaints. pylephlebitis, suppurative cholangitis, gumma of the liver Abdominal lumps are one of the commonest disorders in and hydatid cyst which commonly affects the liver in this region. Different types of abdominal lumps have which right lobe is more commonly involved than the 2,3 been assessed systematically by many clinicians. But left. Carcinoma of the liver which may be either there is a definite need for a comprehensive and primary or secondary as distinguished by Rokitansky in 4 systematic research in this field. In the abdomen, lies a 1849. There may be inflammatory, obstructive etiology fathomless treasure of knowledge, waiting to be or malignancy of extrahepatic biliary apparatus or sub discovered. In this clinical series, an attempt has been phrenic abscess or carcinoma of pylorus of stomach or made to study the different lumps presenting in the right subacute perforation of peptic ulcer or diseases of hepatic hyprochondrium. The lumps in the right hypochondrium flexure of colon which may be intussusceptions, hypertrophic tuberculosis, carcinoma of colon in which a International Surgery Journal | March 2020 | Vol 7 | Issue 3 Page 757 Jayakar SR et al. Int Surg J. 2020 Mar;7(3):757-763 right upper quadrant mass was found in 2.54% of cases Exclusion criteria studied by Barton.5 There may be involvement of right kidney which may include hydronephrosis due to partial Cases of hepatomegaly due to medical condition were not or intermittent obstruction to the outflow of urine.6 It included in this study. Also includes pyonephrosis which is the end stage of an obstructed and infected kidney or renal cell carcinoma After admission, a provisional diagnosis was made, with which occurs most commonly in the fifth to sixth decade the help of a detailed history and through systemic and or renal malignancy like Wilm’s tumour which is the general examination of the patient. Relevant most common solid renal tumor of children accounting investigations were done. Various investigations included roughly for 5% of childhood cancers.7,8 Right laboratory tests, radiological studies, tissue biopsies, fine hypochondriac mass may arise from right adrenal gland needle aspiration cytology and histopathological due to tumour like pheochromocytoma which has an examinations. Laboratory test including routine increased predisposition for the right gland compared to investigations, liver function test, renal function tests and the left.9 relevant serological tests were done. Radiological studies included routine X-rays, intravenous urography, barium Besides knowing the anatomical details of this region, it studies and intra-operative cholangiography. In all cases, is important for every surgeon to be aware of the typical ultrasonography was performed. CT scan abdomen and and atypical presenting clinical features of each disorder. radioisotope uptake studies were performed in cases It is not enough to utilize your clinical features of each wherever indicated. Histopathological examination of the disorder. It is not enough to utilise your clinical skill on respective lumps was done after operation. this region of the abdomen alone. An intelligent surgeon would never forget to make detailed survey of all the After all investigations, the final diagnosis was reached, systems in every patient with such a lump. Apart from the and the clinical accuracy was assessed. The role of diagnosis, various cost-effective investigative techniques investigations in clinching the diagnosis was also studied. have been assessed. With the aid of clinical data and After discharge from the hospital, the patients were investigations, a diagnosis was decided, and a detailed followed up. plan of treatment was chalked out. Statistical methods In this clinical study of sixty patients, a comparative analysis was performed. The clinical presentation, Calculation of data was done by using MS Excel (MS diagnosis, minimal investigations and optimum treatment Office 365). were studied in detail. RESULTS METHODS The data thus obtained was analysed for demographic Place of study was the cases for the present clinical study parameters like age and sex, position of the lump in the were taken from the Sassoon General Hospital, Pune. abdomen whether it is intra or retro-peritoneal, extent of Type of study was the present study was a prospective the lump, organ of origin, etiology whether it is observational study. Duration was carried out from congenital, infectious, malignancy or any other cause, March 2018 to October 2019. main symptomatology at presentation, investigations done and it’s diagnostic accuracy and finally modality of Sample collection treatment given. Sixty cases (sample size) were studied. Out of sixty Table 1: Relation of lumps to the peritoneal cavity. cases, 26.7% cases presented as a lump in the abdomen. The remaining lumps were found at the time of Site of lump No. of patients Percentage examination of patients. Intraperitoneal 39 65* Retro-peritoneal 21 35 Sampling methods Total 60 100 * Intra-peritoneal lumps were more common than retropertoneal Consecutive patients who satisfied the inclusion criteria lumps. were taken up for the study. It was observed that the lumps in the right Inclusion criteria hypochondrium were most common in the 31-40 years age group in the present study and more common in Patients presented as a lump in the abdomen to the males (57%). Intra-peritoneal lumps (65%) were more department of general surgery of Sassoon hospital and common than retroperitoneal lumps (Table 1). As much were willing to be a part of the study were included. as (45%) of the lumps were involving either right lumbar or epigastric region in addition to the right hypochondriac region. Hepatic and renal lumps together accounted for International Surgery Journal | March 2020 | Vol 7 | Issue 3 Page 758 Jayakar SR et al. Int Surg J. 2020 Mar;7(3):757-763 60 percent of the cases. Neoplastic lumps were the Barium meal was done only in the case of choledochal commonest lumps accounting for (45%). Amongst the cyst and was found to help in the diagnosis of this case. malignant lumps, (28.6%) lumps were from the gall bladder. Though malignant lumps were more common Table 2: Extent of lumps. (61.9%) in males, gall bladder malignancies were twice as common in females. Region No. of patients Percentage Exclusively in the 33 55 Only (26.7%) patients presented with the complaint of right hypochondrium lump in abdomen. In the remaining cases, the patients Right came with other presenting complaints
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