Left lower quadrant pain and fever

Abstract

A 55-year-old obese female presents with a 2-day history of left lower quadrant pain, nausea, anorexia, and low-grade fevers. The patient states that the pain is constant, moderately severe, and does not radiate anywhere. She does not recall anything that precipitated the pain. She has not eaten in 24 h as she is not hungry. She has had no bowel movement for 48 h. She denies vomiting and bloody or black stools and has no recent change in bowel habits, though she says she’s been constipated most of her life. She has noted similar pain in the past, but never this severe, and has never sought medical attention before. She has never had a screening colonoscopy. Past history is significant for hypertension and diabetes. She has no prior surgery. On physical examination, her blood pressure is 130/70 mmHg, HR 110 bpm, Temp 101.5 °F, and RR 16/min. Abdominal exam reveals mild distention, no surgical scars, and no masses. Bowel sounds are absent. The left lower quadrant is moderately tender to palpation with guarding and no rebound tenderness. The remainder of the abdomen is nontender. Rectal exam is unremarkable. Pelvic exam reveals no cervical motion tenderness and no adnexal masses. Laboratory exam demonstrates a WBC of 16,000 with a left shift, Hgb of 13 g/dL and Hct of 39 %, normal electrolytes, and normal UA.