A 31-year-old woman presented with a 12-hour history of worsening abdominal pain localizing in the lower abdomen. She had no nausea or vomiting. On abdominal exam she was tender in the right lower quadrant without guarding or rebound. Temperature was normal and WBC count was 15K. Abdominal X-ray had a "ground-glass" appearance in the
right lower quadrant.
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CT scan showed a right lower quadrant phlegmon and no visualization of the appendix. It was unclear if the fluid filled areas within the mass represented loops of bowel or loculated abscess. Radiology felt that if they represented abscess, they were not accessible percutanously because of overlying bowel loops.
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