Question: A 64-year-old woman presented to the emergency department with a 3-day history of right iliac fossa abdominal pain associated with nausea and anorexia but without vomiting. She is otherwise healthy. On examination, she was afebrile with normal vital signs. Her abdominal examination was unremarkable apart from tenderness in the right iliac fossa. Peritoneal irritation was evident by guarding and percussion tenderness. The pain centered predominantly along the mid inguinal point. There was no demonstrable cough impulse.