Right Lower Abdomen Mass: Symptoms, Diagnosis, and Concerns

Hard mass in the right lower abdomen?

Hello, doctor.
Over the past year, I have been experiencing bloating, pain, and diarrhea in my lower right abdomen, occurring approximately once every 3-5 months.
I have visited several clinics, and they seem to think it is irritable bowel syndrome, as I have medical records.
I am quite thin (178 cm/57 kg).
When lying flat, I can feel a protrusion near the groin area in my lower right abdomen, which is painful when pressed firmly, although it sometimes disappears (but is generally easy to feel when lying flat).
The first time I experienced pain in my lower right abdomen, appendicitis was suspected, and I had a blood test, but it was not conclusive.
About 4-5 months ago, I also underwent a fecal occult blood test, which showed no signs of blood.
I would like to ask the doctor if this condition could potentially be a tumor (or even cancer).
Would an ultrasound be able to detect this, or would I need a colonoscopy or something similar? Thank you for your assistance.

AG, 20~29 year old female. Ask Date: 2021/08/06

Dr. Chen Shidian reply Gastroenterology and Hepatology

A colonoscopy is necessary to confirm the absence of colorectal cancer.
A negative fecal occult blood test does not rule out colorectal cancer, so if there are still concerns, it is advisable to discuss them with a physician.

Reply Date: 2021/08/06

More Info

Understanding a mass in the right lower abdomen can be concerning, especially when accompanied by symptoms such as bloating, pain, and diarrhea. Based on your description, it seems that you have been experiencing these symptoms intermittently for about a year, with episodes occurring every 3-5 months. You also mentioned that you are quite thin, which can sometimes complicate the clinical picture.

The presence of a palpable mass in the right lower abdomen, particularly near the groin, raises several possibilities. Given your history of abdominal pain and the initial suspicion of appendicitis, it is essential to consider various differential diagnoses. These could include:
1. Appendiceal Mass or Abscess: Even if you were not diagnosed with appendicitis, an appendiceal mass can form due to inflammation or infection.

2. Hernia: A groin hernia, such as an inguinal hernia, could present as a bulge in the right lower abdomen, especially when lying down or straining. Hernias can cause pain and discomfort, particularly if they become incarcerated or strangulated.

3. Ovarian Cysts or Tumors: In females, ovarian issues can manifest as abdominal masses and may cause pain, especially if they rupture or become twisted.

4. Colonic Issues: Conditions such as diverticulitis, colonic tumors, or inflammatory bowel disease could also present with similar symptoms and findings.

5. Lymphadenopathy: Enlarged lymph nodes in the abdomen can sometimes be felt as masses and may indicate an underlying infection or malignancy.

6. Tumors: While less common, tumors in the gastrointestinal tract or other abdominal organs could present as palpable masses.

Given your symptoms and the presence of a palpable mass, it is advisable to pursue further diagnostic evaluation. An abdominal ultrasound is a good first step, as it is non-invasive and can help visualize the mass and surrounding structures. It can provide information about the nature of the mass (solid vs. cystic), its size, and its relationship to other organs.

If the ultrasound findings are inconclusive or if there is a suspicion of a more serious condition, a CT scan of the abdomen may be warranted. This imaging modality provides a more detailed view and can help identify any underlying pathology, including tumors, abscesses, or hernias.

In some cases, a colonoscopy may be necessary, especially if there are concerns about colonic pathology. This procedure allows direct visualization of the colon and can help identify any abnormalities, such as polyps or tumors.

Regarding your concerns about cancer, while it is understandable to worry, the presence of a mass does not automatically indicate malignancy. Many benign conditions can present similarly. However, given your symptoms and the duration of your issues, it is crucial to have a thorough evaluation by a healthcare professional.

In summary, I recommend scheduling an appointment with your healthcare provider to discuss your symptoms in detail. They can guide you through the appropriate diagnostic steps, which may include an ultrasound, CT scan, or colonoscopy, depending on the findings. Early evaluation and diagnosis are key to managing any potential issues effectively.

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