A 15-YEAR-OLD girl presented with a 2-hour history of severe abdominal pain. The pain was located in the left lower quadrant and was not initially associated with nausea and vomiting. It was neither relieved nor aggravated with movement. She reported similar pain several months earlier, with rapid spontaneous resolution. That episode was considered to be related to a renal stone, but no further testing was performed because she was symptom free at the time of the office visit. She had no history of urinary symptoms.
There was no notable medical history and her last menstrual period was 1 week prior to this presentation.
Physical examination indicated she was afebrile with normal vital signs; however, she was writhing in pain. Bowel sounds were normal and there was no rebound tenderness and no organomegaly. The rectal examination did not reveal a mass or blood.
Laboratory data included a negative pregnancy test result and normal findings from urine analysis. The white blood cell count was 8.1×109/L. An abdominal radiograph (Figure 1) and pelvic ultrasonographic scans (Figure 2) were obtained.
Schwartz G. Radiological Case of the Month. Arch Pediatr Adolesc Med. 1998;152(5):503-504. doi:10.1001/archpedi.152.5.503