A Middle-Aged Woman With Severe Flank Pain

Accompanying vomiting and fever raised suspicion for appendicitis and a CT scan of the abdomen and pelvis was ordered. Watch the ED video, review the history, and make your diagnosis.

A 49-year-old woman arrived at the emergency department after experiencing 12 hours of severe right-sided flank pain accompanied by nausea and vomiting. Her temperature was 38.7°C (101.7°F). She reported no significant past medical history. A CT scan of the abdomen and pelvis was ordered on suspicion of appendicitis. Urinalysis was positive for leukocytes, bacteria, and elevated WBC count.

What do you suspect is the cause of this patient’s pain and infection?