Clinical Case Database / Category: Case Based Discussion

Lower abdominal pain in women of child-bearing age

Publication details

Ashis Banerjee FRCS FCEM, Domike Isiodu MB BS, David Mbamalu FRCS FCEM
Foundation Years Journal, volume 2, issue 3, p.151 (123Doc Education, London, March 2008)


A 29-year-old woman attends the emergency department with a 1-day history of cramping lower abdominal pain, associated with nausea. She has no associated urinary or bowel symptoms. On examination, she is anxious and in pain, with a visual analogue score of 6/10. Apart from a heart rate of 100 beats per minute, her vital signs are within normal limits. Her abdomen is soft, with tenderness in the right lower quadrant. On venous blood testing, her white cell count is 12,000/µL. A urine dipstick confirms pyuria (leucocytes 2 ), with negative nitrites. The urine pregnancy test is negative. How would you proceed to manage her?

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Ashis Banerjee FRCS FCEM (Corresponding author)

Consultant / Honorary Senior Lecturer in Emergency Medicine
Chase Farm Hospital

Domike Isiodu MB BS

Fixed-term Training Grade Doctor
Chase Farm Hospital

David Mbamalu FRCS FCEM

Chase Farm Hospital


1 Hospital Episode Statistics. Department of Health, London, 2003–4.
2. Irvin TT. Abdominal pain: a surgical audit of 1190 emergency admissions. Br J Surg, 1989. 76:1121–1125.
3. Rhea JT, Halpern EF, Ptak T, Lawrason JN, Sacknoff R, Novelline RA. The status of appendiceal CT in an urban medical center 5 years after its introduction: experience with 753 patients. AJR, 2005. 184:1802–1808.
4. Symonds EM, Symonds IM. Essential Obstetrics and Gynaecology , 3rd edition, p 41. Churchill Livingstone, Edinburgh, 1998.
5. Hager WD, Eschenbach DA, Spence MR, Sweet RL. Criteria for diagnosis and grading of salpingitis. Obstet Gynecol, 1983. 61:113–114.
6. Radiation P rotection-118. R eferral guidelines for imaging. European Commission, 2000.


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