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| IMAGE QUIZ |
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| Year : 2014 | Volume
: 2
| Issue : 1 | Page : 60-62 |
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Acute lower abdominal pain in a young female patient
Hassan M Al-Bisher1, Hassan A Al-Saleem1, Ali M Al-Saffar1, Bander F Aldhafery2, Abdulmohsen A Al-Mulhim1
1 Department of Surgery, King Fahd Hospital of the University, College of Medicine, University of Dammam, Dammam, Saudi Arabia
2 Department of Radiology. King Fahd Hospital of the University, College of Medicine, University of Dammam, Dammam, Saudi Arabia
| Date of Web Publication | 7-Mar-2014 |
Correspondence Address:
Abdulmohsen A Al-Mulhim
Department of Surgery, King Fahd Hospital of the University, College of Medicine, University of Dammam, Dammam
Saudi Arabia
 DOI: 10.4103/1658-631X.128458 
How to cite this article:
Al-Bisher HM, Al-Saleem HA, Al-Saffar AM, Aldhafery BF, Al-Mulhim AA. Acute lower abdominal pain in a young female patient. Saudi J Med Med Sci 2014;2:60-2 |
How to cite this URL:
Al-Bisher HM, Al-Saleem HA, Al-Saffar AM, Aldhafery BF, Al-Mulhim AA. Acute lower abdominal pain in a young female patient. Saudi J Med Med Sci [serial online] 2014 [cited 2021 Jan 16];2:60-2. Available from: https://www.sjmms.net/text.asp?2014/2/1/60/128458 |
A 24-year-old multipara women presented with right lower abdominal pain of 2-day duration. Initially, the pain was periumbilical then shifted to right iliac fossa (RIF). She finished her regular menstrual cycle 10 days ago. The rest of the clinical history was unremarkable.
Physical examination, including the vital signs, was unremarkable apart from tenderness at RIF.
A preliminary diagnosis of acute appendicitis versus ovarian pathology was made.
The white blood count was normal.
Abdominal ultrasound failed to visualize the appendix.
Computed tomography (CT) scan with intravenous contrast was made. The coronal [Figure 1] and axial [Figure 2] cuts are shown.
| Questions | |  |
What are the findings?
What is the diagnosis?
| Answer of Quiz | | |
Findings [Figure 3] and [Figure 4] | Figure 3: Coronal CT shows diluted thick-walled appendix (green arrow) and a large appendicolith obstructing the orifice of the appendix (red arrow)
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 | Figure 4: Axial CT shows diluted thick-walled appendix (green arrow) and a large appendicolith obstructing the orifice of the appendix (red arrow)
Click here to view |
Dilated appendix 16 mm (normal diameter is less than 6 mm).
Intense enhancement of the thickened wall of the appendix.
A large appendicolith obstructing the orifice of the appendix.
Diagnosis
Acute appendicitis versus mucocele of the appendix.
| Comments | | |
The patient underwent laparoscopy which revealed acute appendicitis. Laparoscopic appendectomy was performed and histology proved acute appendicitis.
The diagnosis of acute appendicitis in young women is a challenge. Based on the clinical findings, the rate of negative appendectomy, in these patients can reach up to 50%. According to Alvarado scoring system, [1] the diagnosis of acute appendicitis in our patient was unlikely; she had 3 out of 10 scores.
Similar to others experience, the CT scans depicted herein showed classical signs of acute appendicitis. [2],[3]
| References | | |
| 1. | Memon ZA, Irfan S, Fatima K, Iqbal MS, Sami W. Acute appendicitis: Diagnostic accuracy of alvarado scoring system. Asian J Surg 2013;36:144-9. 
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| 2. | Choi D, Park H, Lee YR, Kook SH, Kim SK, Kwag HJ, et al. The most useful findings for diagnosing acute appendicitis on contrast-enhanced helical CT. Acta Radiol 2003;44:574-82.
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| 3. | Rao PM, Rhea JT, Novelline RA. Helical CT of appendicitis and diverticulitis. Radiol Clin North Am 1999;37:895-910.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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