Left Lower Quadrant Pain and Fever

Abstract

A 55-year-old obese female presents with a 2-day history of left lower quadrant (LLQ) pain, nausea, anorexia, and low-grade fevers. The patient states that the pain is constant and moderately severe and does not radiate anywhere. She does not recall anything that precipitated the pain. She has not eaten in 24 hours as she is not hungry. She has had no bowel movement for 48 hours. She denies vomiting or 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, blood pressure is 130/70 mmHg, heart rate 110/min, temperature is 38.2 °C, and respiratory rate is 16/min. Abdominal exam reveals mild distention, no surgical scars, and no masses. Bowel sounds are absent. The LLQ 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 white blood cell (WBC) count of 16 × 10³/μL (normal 4.1–10.9 × 10³/μL) with a left shift, hemoglobin of 13 g/dL (12–15 g/dL) and hematocrit of 39% (35–46%), normal electrolytes, and normal urinalysis.