Diagnose It Answer — April 10, 2026

19-year-old male presents with a 24-hour history of abdominal pain that began as diffuse periumbilical cramping and has since migrated to the right lower quadrant. He rates the pain 8/10, constant, and states it is worse with movement. He vomited twice since this morning and has had no appetite. He tried to walk to his car and says every bump was 'agony.'

No significant past medical history. No prior abdominal surgeries. No current medications. Denies any recent illness, travel, or unusual food intake. Last bowel movement was two days ago. He denies urinary symptoms. He is a college student and states this pain is unlike anything he has felt before.

BP 122/74 mmHg, HR 104 bpm, RR 18 breaths/min, Temp 38.3°C (101.0°F), SpO2 99% on room air. Patient is lying still on the stretcher and grimaces when asked to change position. Abdomen is rigid on initial inspection.

Maximal tenderness on palpation at McBurney's point (one-third the distance from the right anterior superior iliac spine to the umbilicus). Rovsing's sign positive — palpation of the left lower quadrant elicits pain in the right lower quadrant. Psoas sign positive — patient winces with right hip extension. Voluntary guarding noted. Rebound tenderness present. Surgical consult placed.

WBC 14,800/µL with left shift. CRP 62 mg/L. Alvarado score: 8/10 (high probability). Urinalysis: trace blood, no infection. CT abdomen/pelvis with contrast: appendix measures 11mm in diameter, wall thickening, periappendiceal fat stranding, no perforation or abscess identified. Surgical team taking patient to OR for laparoscopic appendectomy.