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Abdominal swellings


Abdominal swellings are a common surgical problem. Abdominal swellings may be divided into generalised and localised swellings. Generalised swellings are classically described as the ‘five Fs’, namely fat, faeces, flatus, fluid or fetus. For the purpose of description of localised swellings, the abdomen can be divided into nine areas, i.e. right upper quadrant, left upper quadrant, epigastrium, umbilical, right lumbar, left lumbar, right iliac fossa, left iliac fossa and suprapubic area. Many of the swellings that occur in the different abdominal regions have similar aetiological causes and therefore have been described according to the organ affected. Hepatomegaly, splenomegaly and renal masses are dealt with under the relevant heading in other sections of the book.

Causes

Abdominal wall

  • ●

    Lipoma

  • ●

    Hernia (i.e. paraumbilical, umbilical, spigelian hernia)

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    Metastatic deposits (i.e. Sister Joseph Mary nodule)

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    Other (i.e. urachal cyst)

Liver

  • ●

    See hepatomegaly, p. 215.

Gall bladder

  • ●

    Secondary to carcinoma of the head of the pancreas

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    Mucocele

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    Empyema

  • ●

    Carcinoma

Stomach

  • ●

    Carcinoma

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    Gastric distension (acute dilatation, pyloric stenosis)

  • ●

    Acute gastric volvulus

Pancreas

  • ●

    Carcinoma

  • ●

    Pseudocyst

Kidney

  • ●

    Hydronephrosis

  • ●

    Solitary cyst

  • ●

    Carcinoma

  • ●

    Polycystic kidney ( Fig. 2 )

    Figure 2, Autosomal dominant polycystic kidney disease .

  • ●

    Pyonephrosis/perinephric abscess

  • ●

    Tuberculosis (TB)

  • ●

    Wilms’ tumour (nephroblastoma)

Spleen

See splenomegaly, p. 393.

Colon

  • ●

    Appendix abscess

  • ●

    Carcinoma (i.e. caecal mass)

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    Faeces

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    Diverticular mass

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    Volvulus (i.e. caecal, sigmoid)

  • ●

    Intussusception

Small bowel

  • ●

    Crohn’s disease

  • ●

    Carcinoma

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    Mesenteric cysts

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    Lymphoma

  • ●

    Ileo-caecal TB

Bladder

  • ●

    Acute retention

  • ●

    Chronic retention

  • ●

    Carcinoma

Ovary/uterus/fallopian tube

  • ●

    Ovarian cyst

  • ●

    Ovarian neoplasm

  • ●

    Pregnancy

  • ●

    Ectopic pregnancy

  • ●

    Tubo-ovarian abscess

  • ●

    Uterine fibroid

  • ●

    Uterine carcinoma

Retroperitoneum

  • ●

    Arterial aneurysm (i.e. aortic, iliac)

  • ●

    Lymphadenopathy (lymphoma, secondaries from testicular carcinoma)

  • ●

    Neoplasm of the iliac bone, e.g. osteogenic sarcoma, Ewing’s tumour

Omentum

  • ●

    Omental secondaries, e.g. stomach and ovary

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