Right Lower Quadrant Abdominal Pain

Abstract

A 25-year-old male presents to the emergency department with a 1-day history of periumbilical abdominal pain which has now shifted to the right lower quadrant. He describes the pain as constant and a seven out of ten. He has vomited twice and reports that he has not eaten for 24 h due to a lack of appetite. Physical examination is significant for a temperature of 99 °F, absent bowel sounds, and marked tenderness to palpation at 1/3 the distance from the anterior superior iliac spine to the umbilicus. When palpating in the left lower quadrant, he reports pain in the right lower quadrant (RLQ). Active flexion of his right hip and internal rotation of the right leg reproduces the pain. His skin in the RLQ is hypersensitive to touch. There is no rebound tenderness. Laboratory values are significant for leukocytosis 13.5 × 10³/μL (normal 4.1–10.9 × 10³/μL), with 15 % bands. The urinalysis demonstrates 1+ WBCs without bacteria.