Sigmoid Colon

• Diverticular mass: tender, ill defined, rubbery hard, non-mobile.
  
• Paracolic abscess: acutely tender, ill defined, ?fluctuant, features of systemic sepsis.
  
• Carcinoma: hard, craggy, non-tender unless perforated, immobile, associated with altered bowel habit/obstructive symptoms.
  
• Faeces: firm, indentable/‘malleable’, mobile with colon.
  
• Normal: only in a thin person, non-tender, chord-like.
  
• Volvulus: usually generalized distension and signs of obstruction rather than localized swelling.

Caecum/Ascending Colon

• Appendix mass/abscess: acutely tender, ill defined, ?fluctuant, features of systemic sepsis.
  
• Carcinoma: hard, craggy, non-tender unless perforated, immobile, associated with anaemia/weight loss and anergia.

Terminal Ileum

• Crohn’s mass: tender, ill defined, rubbery hard, non-mobile, may have features of systemic sepsis is secondary complications such as abscess or localized perforation.
  
• Tuberculous mass: mildly tender, ill defined, firm, associated with cutaneous sinuses, ?systemic TB.

Ovary/Fallopian Tube

• Cyst: may be massive, usually mobile, ?bimanually palpable on PV examination.
  
• Neoplasm.
  
• Ectopic pregnancy: very tender, associated with PV bleeding/intra-abdominal bleeding and collapse.
  
• Salpingo-oophoritis: very tender, bimanually palpable, associated with PV discharge.

Bladder

• Generally: midline swelling, extends up towards umbilicus, dull to percussion, non-mobile, cannot ‘get below’ it.
  
• Retention of urine: stony dull to percussion, associated with desire to pass urine, disappears on voiding/catheterization. May be no desire to pass urine with chronic retention.
  
• Transitional cell carcinoma: hard, irregular, fixed, may be associated with dysuria, haematuria and desire to pass urine on examination.

Uterus

• Pregnancy: smooth, regular, fetal heart sounds heard/movements.
  
• Leiomyoma (‘fibroids’): usually smooth, may be pedunculated and mobile, non-tender, associated menorrhagia.
  
• Uterine carcinoma: firm uterus, may be tender, irregular only if tumour is extrauterine, associated PV bloody discharge.

Rectum

Carcinoma: firm, irregular, non-tender, relatively immobile, associated alteration in bowel habit/PR bleeding.

Urachus (Rare)

Cyst: small swelling in midline, ?associated umbilical discharge.

Other

Pelvic kidney: smooth, regular, non-tender, non-mobile.

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