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JAMA Surgery Clinical Challenge
December 2013

Right Iliac Fossa Pain

Author Affiliations
  • 1Department of Surgery, Mubarak Al-Kabeer Hospital, Kuwait
  • 2Department of Surgery, Faculty of Medicine, Kuwait University
JAMA Surg. 2013;148(12):1159-1160. doi:10.1001/jamasurg.2013.773

A 32-year-old woman presented to the hospital complaining about having colicky abdominal pain for the last 2 weeks. The pain was usually generalized but sometimes radiated to the right iliac fossa. The pain got worse with meals and was associated with nausea but no vomiting. In the last 2 days, the pain was associated with loose stools, but there was no mucus or blood. She had no comorbidities, such as diabetes mellitus or hypertension, and no previous admission to the hospital. She is married and has 4 children; her last child was born 40 days prior to her presentation to the hospital. On examination, her vital signs were normal (temperature, 37.1°C; pulse, 86 beats/min; and blood pressure, 121/86 mm Hg). Her abdomen was soft and lax. There was mild tenderness in the right iliac fossa, but no lump or lumps were felt. Bowel sounds were not exaggerated. Her white blood cell count was 8500/μL (to convert to ×109 per liter, multiply by 0.001), her hemoglobin level was 1.3 g/dL (to convert to grams per liter, multiply by 10.0), and her platelet count was 361 × 103/μL (to convert to ×109 per liter, multiply by 1.0). The results of renal and liver function tests were normal.