Article Sidebar

Submitted
December 17, 2025
Accepted
December 17, 2025
Published
December 14, 2025
Download
PDF
Statistic
Read Counter : 271 Download : 256

Main Article Content

Abstract

Evaluating female patients with severe lower abdominal pain in the casualty department
presents a significant diagnostic challenge due to the presence of multiple pelvic organs
with overlapping symptoms. Conditions such as pelvic inflammatory disease,
endometriosis, ovarian cysts, urinary tract infections, and acute appendicitis often mimic
one another. Among these, differentiating right ovarian cysts from acute appendicitis is
particularly difficult because both can present with similar right lower abdominal pain.This
study aimed to differentiate them clinically based on history, clinical examination, and
laboratory studies .The history of presentation is based on an analysis of pain (including
severity, duration, time and location of onset, nature of pain, and associated symptoms
such as nausea or vomiting), as well as factors like loss of appetite, abdominal distension,
fever, frequency of urination, vaginal bleeding, irregular menstrual cycles, hormonal drug
history, trauma to the abdomen, gynecological history, and surgical history. Physical
examination relies on inspection, palpation, percussion, and auscultation. Our investigation
indicates that acute appendicitis can induce abrupt and strong pain in the lower abdomen.
A pain starts in the middle of the abdomen, around the belly button, and typically in the
right iliac fossa. It could come and go for a few hours, and the pain moves to the lower
right side of the abdomen. will lead to nausea and vomiting, the nausea goes away after a
few hours, and the fever is caused by the immune system. (feel sick in general). This is
because the appendix is bothering the colon next to it .Symptoms of ovarian cysts that
don't involve speaking include pelvic pain, a feeling of fullness or pressure in the
abdomen, bloating, changes in bowel habits (like constipation or trouble going to the
bathroom), urinary problems (like needing to urinate often or having trouble emptying the
bladder), and in some cases, problems with fertility or irregular periods. Yet when these
symptoms change, they get worse when a cyst gets bigger, breaks, or twists.To tell the
difference between acute appendicitis and a right ovarian cyst, you need to do a full
history, physical exam, blood testing, and imaging studies. For the safety of the patient, it
is important to resuscitate them quickly in the emergency room using intravenous fluids,
blood transfusions, antibiotics, and bladder catheterization before surgery.

Keywords

appendix, right overian cyst, causlty room overies history

Article Details

License

Copyright (c) 2025 Akeel abdali al-omeri

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

References

  1. Gignoux B, Blanchet MC, Lanz T, Vulliez A, Saffarini M, Bothorel H, Robert M, Frering V. Should ambulatory
  2. appendectomy become the standard treatment for acute appendicitis? World J Emerg Surg. 2018;13:28. [PMC free article]
  3. [PubMed]
  4. Khan MS, Chaudhry MBH, Shahzad N, Tariq M, Memon WA, Alvi AR. Risk of appendicitis in patients with incidentally
  5. discovered appendicoliths. J Surg Res. 2019 Jan;221:84-87. [PubMed].
  6. Vaos G, Dimopoulou A, Gkioka E, Zavras N. Immediate surgery or conservative treatment for complicated acute
  7. appendicitis in children? A meta-analysis. J Pediatr Surg. 2019 Jul;54(7):1365-1371. [PubMed]
  8. Cathcart AM, Gimovsky ML, Koelper N, et al. Adnexal masses during pregnancy: diagnosis, treatment,andoutcome.Am J
  9. Obstet Gynecol. 2023;228(3):B19-B35. DOI:10.1016/j.ajog.2022.11.030
  10. Bruno M, Iodice R, Fatuzzo S, et al. Ultrasound features and clinical outcome of patients with ovarian masses during
  11. pregnancy. Diagnostics (Basel). 2023;13(20):3247. DOI:10.3390/diagnostics13203247
  12. Andrieu PIC, Uzan J, Luton D, et al. Ovarian cancer during pregnancy. Best Pract Res Clin Obstet Gynaecol.
  13. ;89:102-113. DOI:10.1016/j.bpobgyn.2023.03.005
  14. Didar H, Keshavarzi A, Hosseini M, et al. Adnexal torsion in pregnancy: A systematic review of case reports and case
  15. series. Int J Gynaecol Obstet. 2023;160(2):469-479. DOI:10.1002/ijgo.14618
  16. Kartal İ. Childhood neuroendocrine tumors of the digestive system: A single center experience. Medicine (Baltimore). 2022
  17. Feb 11;101(6):e28795. [PMC free article]
  18. Stringer MD. Acute appendicitis. J Paediatr Child Health. 2018 Nov;53(11):1071-1076. [PubMed]
  19. Garde I, Vázquez-Manjarrez SE, Ajao M, et al. Diagnostic accuracy of ultrasound signs for detecting adnexal torsion:
  20. systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2023;61(4):487-497. DOI:10.1002/uog.26250
  21. Pascual MA, Tardáguila FM, Salas Á, et al. Validation of ADNEX and IOTA two-step strategy for classifying adnexal
  22. masses in low-risk outpatients. Ultrasound Obstet Gynecol. 2024;64(6):882-891. DOI:10.1002/uog.27642
  23. Borges AL, Caldas R, Silva T, et al. Prospective external validation of IOTA methods for classifying adnexal masses.
  24. Ultrasound Obstet Gynecol. 2024;64(3):393-402. DOI:10.1002/uog.27641
  25. Eng KA, Abadeh A, Ligocki C, Lee YK, Moineddin R, Adams-Webber T, Schuh S, Doria AS. Acute Appendicitis: A
  26. Meta-Analysis of the Diagnostic Accuracy of US, CT, and MRI as Second-Line Imaging Tests after an Initial US.
  27. Radiology. 2018 Sep;288(3):717-727. [PubMed]
  28. Ucar Karabulut K, Erinanc H, Yonar A, Kisinma A, Ucar Y. Correlation of histological diagnosis and laboratory findings
  29. in distinguishing acute appendicitis and lymphoid hyperplasia. Ann Surg Treat Res. 2022 Nov;103(5):306-311. [PMC free
  30. article] [PubMed]
  31. Narula N, Gibbs KE, Kong F, Mukherjee I. Appendiceal Intussusception, Diverticula, and Fecalith Associated With
  32. Appendicitis. Am Surg. 2023 Dec;89(12):6257-6259. [PubMed]
  33. Barcroft J, Smith A, McNally L, et al. Evaluating use of two-step IOTA strategy for classifying adnexal masses during
  34. pregnancy: prospective study. Ultrasound. 2024;32(4):231-241. DOI:10.1177/1742271X24104571
  35. Sahm M, Koch A, Schmidt U, Wolff S, Pross M, Gastinger I, Lippert H. [Acute appendicitis - clinical health-service
  36. research on the current surgical therapy]. Zentralbl Chir. 2019 Jun;138(3):270-7. [PubMed]
  37. Kim J, Kim S-H. Diagnostic imaging of adnexal masses in pregnancy. Obstet Gynecol Sci. 2023;66(6):473-486.
  38. DOI:10.5468/ogs.22287
  39. Téoule P, Laffolie J, Rolle U, Reissfelder C. Acute Appendicitis in Childhood and Adulthood. Dtsch Arztebl Int. 2020
  40. Nov 06;117(45):764-774. [PMC free article] [PubMed]
  41. Smith AV, D’Angelo D, Razavi AS, et al. Laparoscopic treatment of benign adnexal masses during pregnancy. Clin Obstet
  42. Gynecol. 2022;65(2):342-353. DOI:10.1097/GRF.0000000000000783
  43. Yin M, Dong G, Xu D, et al. Decidualized ovarian endometrioma mimicking malignancy in pregnancy: case report and
  44. literature review. J Ovarian Res. 2022;15:33. DOI:10.1186/s13048-022-00966-6
  45. Buckius MT, McGrath B, Monk J, Grim R, Bell T, Ahuja V. Changing epidemiology of acute appendicitis in the United
  46. States: study period 2019-2022. J Surg Res. 2019 Jun 15;175(2):185-90. [PubMed]
  47. Panico C, Palmieri M, Del Prato S, et al. Prediction of the risk of malignancy of adnexal masses using non-contrast MRI
  48. scores in pregnancy. Cancers (Basel). 2023;15(19):4861. DOI:10.3390/cancers15194861
  49. Hamilton AL, Kamm MA, Ng SC, Morrison M. Proteus spp. as Putative Gastrointestinal Pathogens. Clin Microbiol Rev.
  50. Jul;31(3) [PMC free article] [PubMed]
  51. Masselli G, Brunelli R, Di Pastena M, et al. Review of imaging modalities in gynecological oncology during pregnancy.
  52. Cancers (Basel). 2025;17(10):1623. DOI:10.3390/cancers17101623
  53. J Matern Fetal Neonatal Med. 2021:1090-1093
  54. Bulun SE, Babayev E. Physiology and pathology of the female reproductive axis. In Melmed S, Auchus RJ, Goldfine AB,
  55. Rosen CJ, Kopp PA, eds. Williams Textbook of Endocrinology. 15th ed. Philadelphia, PA: Elsevier; 2025:chap 15.
  56. Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States.
  57. Am J Epidemiol. 2020Nov;132(5):910-25. [PubMed]
  58. Redden M, Ghadiri M. Acute appendicitis with associated trichobezoar of feline hair. J Surg Case Rep. 2022
  59. Mar;2022(3):rjac133. [PMC free article] [PubMed]
  60. Hsu WL, Wu TT, Chen CH, et al. Decidualized endometrioma mimicking malignancy: imaging clues to avoid
  61. unnecessary surgery in pregnancy. J Radiol Sci. 2023;48(2):89-97. DOI:10.1016/j.jrs.2023.05.001
  62. Patel-Lippmann KK, Dillman JR, Brook A, et al. ACR Appropriateness Criteria®: Clinically suspected adnexal
  63. mass.
  64. J Am Coll Radiol. 2024;21(10S):S280-S295. DOI:10.1016/j.jacr.2024.05.007
  65. Dolan MS, Hill CC, Valea FA. Benign gynecologic lesions: vulva, vagina, cervix, uterus, oviduct, ovary, ultrasound
  66. imaging of pelvic structures. In: Gershenson DM, Lentz GM, Valea FA, Lobo RA, eds. Comprehensive Gynecology. 8th
  67. ed. Philadelphia, PA: Elsevier; 2022:chap 18.
  68. Moro F, Mascilini F, Leone FP, et al. External validation of ultrasound-based models (IOTA phase 6) for differentiating
  69. benign vs malignant adnexal masses: nationwide prospective multicenter study. Am J Obstet Gynecol.
  70. ;233(2):S0002-9378(25)00477-6. DOI:10.1016/j.ajog.2025.04.020
  71. Phillips CH, Patel-Lippmann KK. Ovarian-Adnexal Reporting and Data System (O-RADS) ultrasound: principles and
  72. applications. Radiol Clin North Am. 2025;63(1):1-15. DOI:10.1016/j.rcl.2024.10.002
  73. Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern understanding of pathogenesis,
  74. diagnosis, and management. Lancet. 2021 Sep 26;386(10000):1278-1287. [PubMed]
  75. Brown DL, Wall DJ. Ultrasound evaluation of the ovaries. In: Norton ME, Scoutt LM, Feldstein VA, eds. Callen's
  76. Ultrasonography in Obstetrics and Gynecology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 30.

Similar Articles

You may also start an advanced similarity search for this article.