A 22-Year-Old College Athlete With Abdominal Symptoms

A 22-year-old woman presents to urgent care with a 2-day history of progressive abdominal discomfort. She first noticed the vague onset of generalized abdominal discomfort and anorexia. This was not relieved by bowel movements. Over the next 2 days, the discomfort lateralized to the right lower quadrant and has progressively worsened. She did not report any emesis. She is otherwise quite healthy with no chronic major medical diagnoses. She has used oral contraceptives for several years without difficulty. Her menses are light but normal and are not accompanied by cramps. Her last menstrual period was 2 weeks ago. She attends university and is a scholarship varsity basketball athlete. Basketball is in the off season, but she has a program to maintain cardiovascular and muscular fitness until the formal preseason training program begins 3 months from now, with the regular season starting thereafter. Physical examination findings showed a well-developed woman most comfortable in a flexed hip position. She has a temperature of 37.5 ̊C, a pulse rate of 92 beats/min, and a blood pressure of 110/70 mm Hg. Pertinent findings include 3+ tenderness to direct palpation in the right lower quadrant with a component of rebound. Rectal examination findings were negative, including results of a hematest of her stool. Results of a laboratory screening showed normal levels of hemoglobin and platelets with a white blood cell count of 10,800/mm3, with 88% polymorphonuclear leukocyte forms and 4% band forms. A urinalysis was negative for red and white blood cells. A discussion of management was initiated pending a radiologic study.