Palpable abdominal mass

Specialty: Gastrointestinal.

• Palpable intra-abdominal tumor
• palpable abdominal lump
• palpable mass in abdomen

Why it occurs

• Colorectal adenocarcinoma (especially in the right colon or cecum, where the tumors usually reach large dimensions before generating obstructive symptoms)
• Splenomegaly or giant hepatomegaly secondary to myeloproliferative disorders, cirrhosis with congestion or lymphoma
• Large diameter abdominal aortic aneurysm (expanding pulsatile mass located in the mesogastrium or epigastrium)
• Pancreatic pseudocyst post-acute pancreatitis or intra-abdominal abscess (diverticular, appendicular or tuberculous)
• Giant ovarian cyst or large-volume pedunculated uterine fibroid in the pelvis and lower abdomen.

Initial workup

CT of the abdomen and pelvis with double contrast (oral and intravenous with arterial and venous phase; definitive study of diagnostic choice to specify origin, vascularization and extension of the mass) | Abdominal ultrasound (useful to differentiate between cystic, solid or vascular masses in the first instance) | Colonoscopy or upper gastrointestinal endoscopy if origin in the gastrointestinal lumen is suspected | Determination of tumor markers (CEA, CA 19-9, AFP, CA 125) and general analysis with blood count and kidney function.

Standard management

• Broad-spectrum intravenous antibiotic therapy if an inflammatory mass or intra-abdominal abscess is confirmed — piperacillin/tazobactam 4.5 g IV every 6 hours, or combination of ceftriaxone 2 g IV every 24 hours plus metronidazole 500 mg IV every 8 hours
• Intravenous analgesics with central or peripheral action — metamizole 1-2 g IV or fentanyl, avoiding NSAIDs due to the risk of gastrointestinal bleeding or associated renal failure
• Enteral or parenteral nutritional support in patients with obstructive masses or tumor cachexia.