Case 5

A 22-year-old man presents to the ED with subacute onset abdominal pain and fever. Pain started about a week ago and has been getting progressively worse. The pain primarily localizes to the right lower quadrant. Fever started this morning, and a temperature checked at home was 101.8. He endorses nausea, anorexia, and three episodes of non-bloody, non-bilious emesis in the last 24 hours. He denies diarrhea; he states his last bowel movement was over 24 hours ago, though he is still passing gas. He is otherwise healthy; however, he notes intermittently having much more mild pain in a similar location for the last couple years, sometimes associated with postprandial bloating. He would typically take either ibuprofen or acetaminophen for this pain, but it was never severe enough to cause him to seek medical attention. His family history is notable for a cousin with inflammatory bowel disease. He admits to smoking about 10 cigarettes per day as well as occasional marijuana and consumes about 4-5 alcoholic drinks per week.

Notable Physical Exam Findings:

Vitals: Temp 101.5, HR 95, RR 14, BP 105/64

General: Uncomfortable appearing, anxious

Abdomen: Tender to palpation in the right lower quadrant with guarding, hyperactive bowel sounds, mild distention

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