A 52-year-old previously healthy man presented to the emergency department with gradual onset of severe right lower quadrant abdominal pain over the course of 24 hours. The patient did not have a fever and he was hemodynamically normal. Laboratory workup revealed leukocytosis with a white blood cell count of 11 600/μL (to convert to ×109/L, multiply by 0.001). Physical examination revealed tenderness in the right lower quadrant without overt signs of peritonitis. The patient reported undergoing an appendectomy when he was 10 years old. Abdominal computed tomography was obtained (Figure 1).
Pernar LIM, Mongiu A, Sheu EG. An Unusual Cause of Intestinal Perforation. JAMA Surg. 2017;152(2):199–200. doi:10.1001/jamasurg.2016.4614