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JAMA Surgery Clinical Challenge
October 2013

Right Lower Quadrant Pain

Author Affiliations
  • 1Department of Radiology, Hospital Universitario y Politécnico la Fe, Valencia, Spain
  • 3Department of Radiology, Hospital Clínico Universitario, Valencia, Spain
  • 2Department of Surgery, Hospital Universitario y Politécnico la Fe, Valencia. Spain
JAMA Surg. 2013;148(10):981-982. doi:10.1001/jamasurg.2013.311

A 50-year-old man presented to the emergency department with a 4-day history of right lower quadrant pain that did not migrate during that period of time. On examination, he tested positive for the Blumberg sign. Blood analysis showed leucocytosis, neutrophilia, and an increased level of C-reactive protein. Ultrasonographic (Figure, A) and computed tomographic images (Figure, B) showed a thickened wall outpouching arising from a discreetly thickened appendix and inflamed surrounding fat. Right-sided colonic diverticulosis was also seen. The patient underwent an appendectomy with gross findings as shown in Figure, C.

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