CASE 2: RIGHT ILIAC FOSSA PAIN

History

A 19-year-old man presents with a 2-day history of abdominal pain. The pain started in the central abdomen and has now become constant and has shifted to the right iliac fossa.
The patient has vomited twice today and is off his food. His motions were loose today, but there was no associated rectal bleeding.

Examination

The patient has a temperature of 37.8°C and a pulse rate of 110/min. On examination of his abdomen he has localized tenderness and guarding in the right iliac fossa. Urinalysis is clear.

Investigations

Haemoglobin                  14.2 g/dL                                  11.5–16.0 g/dL
Mean cell volume            86 fL                                         76–96 fL
White cell count              19 109/L                                   4.0–11.0 109/L
Platelets                            250 109/L                              150–400 109/L
Sodium                               136 mmol/L                            135–145 mmol/L
Potassium                        3.5 mmol/L                              3.5–5.0 mmol/L
Urea                                      5.0 mmol/L                             2.5–6.7 mmmol/L
Creatinine                         62 μmol/L                               44–80 μmol/L
C-reactive protein         20 mg/L                                    5 mg/L

Questions

• What is the likely diagnosis?
• What are the differential diagnoses for this condition?
• How would you manage this patient?
• What are the complications of any surgical intervention that may be required?

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Posted in: 100 Cases In Surgery,100 Cases Series - Clinical Scenarios