12 January 2026
: Case report 
Atypical Appendicitis Mimicking Gynecological Pathology: A Diagnostic Challenge in a Middle-Aged Woman
Unusual clinical course, Challenging differential diagnosis, Unusual setting of medical care
Uma Hemant Chourasia
ABDEF 1*
DOI: 10.12659/AJCR.949850
Am J Case Rep 2026; 27:e949850
Table 1 Timeline of presentation, evaluation, and management.
| Date | Event/symptoms | Evaluation/findings | Management/outcome |
|---|---|---|---|
| April 22, 2024 | Mild lower abdominal pain | CBC: normal; urine dipstick: negative; USG: small simple right ovarian cyst | Presumptive PID → IUCD removed; doxycycline + metronidazole (14 days) |
| May 8, 2024 | Persistent pain | USG abdomen: prominent appendix without inflammation; CBC: normal; urine culture: no growth | Conservative management (“wait and watch”) |
| May 14, 2024 | Referred to Jazan University Hospital; persistent suprapubic pain | Clinical examination: mild suprapubic tenderness, no peritonitis; USG: bilateral simple ovarian cysts; cervix inflamed | Cervical smear advised; symptomatic care; referred to surgery/urology |
| May 15, 2024 | Acute severe pain localized to right iliac fossa | CT scan: bilateral ovarian cysts; appendix 6 mm, equivocal changes | Emergency laparoscopic appendectomy performed; inflamed appendix removed |
| Post-operative period | Recovery | Uneventful postoperative course | Discharged in good condition; histopathology confirmed early acute appendicitis |
| 6-month follow-up | Asymptomatic | No recurrence of pain or complications | Complete resolution of symptoms |
| CBC – complete blood count; CT – computed tomography; IUCD – intrauterine contraceptive device; PID – pelvic inflammatory disease; USG – ultrasonography. | |||