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Chronic Appendicitis: An Often Forgotten Cause of Recurrent Abdominal Pain

Published:November 21, 2012DOI:https://doi.org/10.1016/j.amjmed.2012.05.032
      A 28-year-old woman presented with a 3-day history of worsening abdominal pain localized to the right lower quadrant. Her symptoms began with a sharp discomfort originating along the right abdomen with associated radiation to the lower back. She recalled no inciting event and denied fevers, nausea, vomiting, diarrhea, hematuria, dysuria, or vaginal discharge. She reported compliance with a hormonal contraception vaginal ring prescribed for “menstrual pain.” On further questioning, the patient had experienced 6 similar episodes of right-sided abdominal pain over the past 2 years, each resolving spontaneously after 3-4 days with conservative measures. She was evaluated on several occasions for this pain with no clear diagnosis. At one point she was treated with antibiotics for a presumed urinary tract infection. She had never undergone computed tomography (CT) imaging.
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