Acute Right Lower Quadrant Abdominal Pain Diagnosis

Primary Differential Diagnoses

The American College of Radiology recommends that acute appendicitis be ruled out immediately in patients with right lower quadrant pain, fever, and localized tenderness, given its classic presentation and potential for severe complications 1, 2
The World Journal of Emergency Surgery suggests that a fever of 101°F with tachycardia significantly increases the probability of appendicitis in patients with right lower quadrant pain 2, 4
The American Academy of Family Physicians states that the 24-hour progression from diffuse abdominal pain to localized right lower quadrant pain follows the typical appendicitis pattern, and CT abdomen/pelvis with IV contrast is the diagnostic test of choice with 94% sensitivity for appendicitis 3, 5

The American College of Radiology recommends CT abdomen/pelvis with IV contrast as the single best test for patients with fever and localized right lower quadrant pain, with a sensitivity of 94% for appendicitis 1, 5
The World Journal of Emergency Surgery suggests that plain radiographs have limited utility in detecting inflammatory processes, with only 49% sensitivity for obstruction 1, 5

The World Journal of Emergency Surgery states that fever ≥38°C (101°F) with localized abdominal pain indicates possible intra-abdominal infection requiring source control, and pain with movement suggests peritoneal irritation 2, 4

The World Journal of Emergency Surgery recommends immediate stabilization with IV access, fluid resuscitation, and nothing by mouth, followed by stat laboratory tests and urgent CT abdomen/pelvis with IV contrast 2
The American College of Radiology suggests that surgical consultation should occur simultaneously with imaging, given the high suspicion of appendicitis or other surgical pathology 1, 2