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 that you would like to suggest for a future Case Challenge, please contact us .
A 24-year-old man presents to the emergency department (ED) with sudden right lower quadrant abdominal pain, nausea, and vomiting. Before the onset of these symptoms, he was feeling well. The pain is constant and intense, limiting his movements. It radiates to the right flank but not to the groin. He says he does not have fever, weight loss, diarrhea, bloody stool, urinary symptoms, or gross hematuria. Thorough questioning reveals no recent trauma, extreme physical activity, infectious contacts, travel, or unprotected sexual intercourse.
His past medical history and a detailed family history are both unremarkable. He has no allergies and does not take any medications regularly. He specifically denies taking nonsteroidal anti-inflammatory drugs and acetaminophen. He does not smoke, but he drinks alcohol occasionally. He mentions using recreational intranasal cocaine. His last exposure was 4 days ago during what he describes as a "wild" party.
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Cite this: Marie-Lee Simard, Alexandre Lafleur. Intense Abdominal Pain After a Night of Partying - Medscape - Aug 10, 2023.