Author: Emily DeMaio, BSN
Co Author #1: Richard C. Jarvis III, BA Emory University School of Medicine
Co Author #2: Jessica A. Cohen, PT, DPT, MAT, ATC The Portland Trailblazers
Co Author #3: Courtney N. Gleason, MD Department of Orthopedics, Sports Medicine, Emory University
Senior Editor: Mandeep Ghuman, MD, FAMSSM
Editor: Caitlyn Mooney, MD

Patient Presentation:
A 26-year-old African American female basketball player with no significant past medical history presented to the emergency department with a seven-hour history of worsening, sharp, non-radiating 7/10 abdominal pain exacerbated by movement.

History:
The pain began in the epigastric region and migrated to the right lower quadrant. Nothing alleviated the pain. The athlete reported worsening nausea and experienced an initial episode of emesis in the emergency department. The athlete denied the presence of diarrhea, constipation, fever, chills, vaginal discharge, or dysuria. She had not had any changes to her stool frequency with her last bowel movement the day prior to presentation. Her last menstrual period was three weeks prior. She had no known sick contacts. She had no recent changes to her diet and had not consumed food prepared outside the home in the last day. Since the onset of pain, the athlete had not consumed any solids or liquids. The athlete endorsed that she had never experienced pain like this previously. The athlete reported a low likelihood of pregnancy, no family or personal history of gastrointestinal disorders, and no abdominal surgical history. The athlete was not taking any prescribed or over the counter medications and denied use of alcohol, tobacco, or recreational drugs. She had no known drug allergies. The review of systems was otherwise negative.

Physical Exam:
Vital signs: Temperature 36.8 degrees Celsius, blood pressure of 131/65 millimeters of mercury, heart rate of 60 beats per minute, and respiratory rate of 16 breaths per minute with an oxygen saturation of 99% on room air. On physical exam, the athlete was in apparent discomfort, clutching her abdomen. The cardiac and respiratory exams were normal. Her abdomen was non-distended with normal bowel sounds in all four quadrants and no tympany to percussion. She was tender to light and deep palpation in the right lower quadrant but did not exhibit guarding or rebound during the initial examination. She did not have any suprapubic or costovertebral angle tenderness. Pelvic exam was deferred on initial examination. On subsequent examination six hours later, the exam was unchanged except for a new finding of rebound tenderness in the right lower quadrant.

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