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