Clinics in General Practice. A case of right iliac fossa pain.

Abstract

The trainee's problem The patient is a 16-year-old girl and the elder daughter of intensely religious school-teaching parents. She herself has always seemed a fairly happy child and has recently been "converted" to the same beliefs her parents hold-apparently of her own free will and without regret. She attends the local comprehensive school and is making adequate progress. She is hoping to enter nursing, and her parents seem pleased about this.Her medical history was fairly uneventful until about two years ago since when she has had recurring bouts of abdominal pain, sometimes in the centre of the abdomen and colicky, sometimes in the right iliac fossa and more constant. It is difficult to determine any pattern underlying these attacks, which have now produced some eight episodes of consultation. During one episode a year ago she was admitted to hospital as having possible acute appendicitis. Her pain settled quickly, and no operation was needed. No cause for her symptoms was found, and the discharge diagnosis was, perhaps unfortunately, mild acute appendicitis. Two months ago she was again seen at hospital on her own initiative-at a weekend when another practice was covering but was not admitted. I saw her again yesterday with stabbing pain in the right iliac fossa. She is