Case 28-1991

Presentation of Case A 41-year-old woman was admitted to the hospital because of pain in the right lower abdominal quadrant. The patient was well until 36 hours earlier, when she experienced the onset of an insidious, throbbing "ache" in the right lower quadrant of the abdomen, accompanied by anorexia, nausea, and one episode of vomiting of a small amount of bilious liquid without blood. On the following day she consulted a physician, who prescribed bismuth subsalicylate and acetaminophen. The pain became more persistent, awakening the patient from sleep, and remained vaguely localized to the right lower abdominal quadrant. The patient . . .