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Acute Appendicitis vs. Ovarian Torsion: The Challenge of Diagnosing Right Iliac Fossa Pain with Abdominal Ultrasound and Inflammation Markers

A Hispanic female doctor in a white coat and stethoscope shows a young Hispanic woman an abdominal diagram on a tablet, explaining the location of the appendix and ovaries. The patient, with a worried expression, touches her lower abdomen. The scene reflects a professional and calm environment, emphasizing the importance of accurate diagnosis in cases of acute abdominal pain, such as acute appendicitis or ovarian torsion, and the role of abdominal ultrasound and inflammation markers in clinical assessment.

The acute abdominal pain is one of the most common presentations in emergency services, and its differential diagnosis can be a true challenge. Among the most frequent causes of pain in the right iliac fossa are acute appendicitis and ovarian torsion. Both conditions require rapid and accurate diagnosis to avoid serious complications. In this context, abdominal ultrasound and inflammation markers play a crucial role in the initial evaluation.

Profundizando en el diagnóstico diferencial

Acute appendicitis is the most common cause of abdominal pain requiring surgery in adolescents, with a peak incidence during adolescence. Classic clinical signs include pain in the right lower quadrant, nausea, vomiting, and fever. However, these symptoms can be nonspecific, especially in young women, where ovarian torsion must be considered in the differential diagnosis. Ovarian torsion, although less common, is a gynecological emergency that can lead to loss of the ovary if not treated promptly.

Abdominal ultrasound is the preferred imaging modality for evaluating acute abdominal pain in children and young women due to its low cost, ease of use, and absence of ionizing radiation. In the case of appendicitis, ultrasound findings include a dilated and non-compressible appendix. For ovarian torsion, color Doppler ultrasound may show decreased or absent blood flow to the affected ovary. However, in some cases, magnetic resonance imaging may be necessary to clarify findings when ultrasound is inconclusive.

In addition to imaging, inflammation markers such as C-reactive protein and white blood cell count can help differentiate between these two conditions. A recent study suggests that the direct bilirubin to lymphocyte ratio may be useful in distinguishing between appendicitis and ovarian torsion, being higher in cases of appendicitis [1].

Conclusiones

The differential diagnosis between acute appendicitis and ovarian torsion is crucial for the proper management of right iliac fossa pain. The combination of a detailed clinical evaluation, the use of abdominal ultrasound, and, when necessary, magnetic resonance imaging, along with the interpretation of inflammation markers, can guide physicians toward an accurate diagnosis. Early identification and appropriate treatment are essential to prevent complications and preserve patient health.

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Created 6/1/2025