Intended for healthcare professionals

Endgames Spot Diagnosis

An unusual cause of right iliac fossa pain

BMJ 2018; 363 doi: (Published 14 November 2018) Cite this as: BMJ 2018;363:k4153
  1. Omed Amin, foundation year two doctor,
  2. David C Howlett, consultant radiologist
  1. Eastbourne District General Hospital, East Sussex Healthcare NHS Trust, Eastbourne, UK
  1. Correspondence to O Amin omedamin{at}

A 34 year old woman presented to the emergency department with a history of worsening right iliac fossa pain over several days. She described the pain as alternating dull and sharp, and had found simple analgesia (paracetamol, non-steroidal anti-inflammatory drugs) to be ineffective. She had no other associated signs or symptoms and no history other than insertion of an intrauterine contraceptive device (IUCD) several years ago.

A transvaginal ultrasound was unremarkable except that it showed a trace of free fluid in the pelvis, close to the uterus, and the IUCD was not visualised. The patient …

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