21-year-women presented to Emergency Room with right lower quadrant pain and anorexia.

الشرح

Core Concept: In a young woman presenting with RLQ pain, anorexia, tenderness, rebound, and leukocytosis, the differential diagnosis is broad (appendicitis, ovarian pathology, ectopic pregnancy, PID, mesenteric adenitis). While the clinical picture suggests appendicitis, in a female of reproductive age, imaging is crucial to confirm diagnosis and exclude gynecological pathology before committing to surgery.

Clinical Presentation:

• RLQ pain (migrating from periumbilical), anorexia, nausea.
• RLQ tenderness, rebound tenderness (peritoneal irritation).
• Low-grade fever, leukocytosis.
• Differential: Ovarian cyst rupture/torsion, ectopic pregnancy, PID, mesenteric adenitis.
• Complications: Perforation, abscess, peritonitis.

Diagnosis:

• First-line tool: Urine pregnancy test (mandatory in females) + FBC + CRP. Ultrasound pelvis to exclude gynecological pathology.
• Gold standard: CT abdomen/pelvis with IV contrast (sensitivity >95% for appendicitis). Shows appendix diameter >6mm, wall thickening, periappendiceal fat stranding.

Management:

• Acute: CT abdomen to confirm diagnosis and exclude alternatives. NPO, IV fluids, analgesia, IV antibiotics.
• Long-term/Definitive: If appendicitis confirmed: Laparoscopic appendectomy (gold standard). If abscess: Percutaneous drainage + interval appendectomy at 6-8 weeks. If gynecological pathology: Gynecology referral.