A 30-Year-Old Woman With Lower Abdominal Pain

D. Brady Pregerson, MD

Disclosures

June 15, 2016

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 30-year-old woman with no significant medical history presents to the emergency department with intermittent nonradiating pain in the lower left part of her abdomen. The pain started approximately 5 days ago and has been steadily worsening since then. She has also been having fever.

At presentation, the patient describes the pain as "severe" and notes that it increases with any motion. No abnormal urinary symptoms are reported (ie, pain during urination or increased frequency of urination). She has not had any changes in her bowel habits, including no constipation or diarrhea.

She is married and monogamous, and her last sexual intercourse was 2 weeks ago. She has regular menses, with her last menstrual period occurring approximately 3 weeks ago. No vaginal discharge is observed. She has no history of sexually transmitted diseases (STDs). She does not smoke and does not use any illicit substances.

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