Suspected Appendicitis

Abstract

An otherwise healthy 22-year-old woman comes to the emergency department with acute abdominal pain of 18 hours' duration in the right lower quadrant. On physical examination, she is afebrile, with tenderness on deep palpation in the right lower quadrant, and has no peritoneal signs. Pelvic examination reveals tenderness in the right adnexa without a mass. How should this patient be further evaluated?