Acute Right Lower Quadrant Pain with Nocturnal Pattern in Young Adult

Case at a Glance

A 20-year-old male presented with a 3-day history of severe nocturnal abdominal cramping, initially generalized but later localizing to the right lower quadrant, associated with excessive salivation and postprandial pain.

Patient's Story

The patient reported experiencing severe abdominal cramping for three consecutive nights. The pain was initially generalized but became more pronounced in the lower right abdomen on the third night, described as throbbing and severe. The cramping episodes occurred primarily at night and when eating. Associated symptoms included excessive salivation requiring frequent spitting. The patient had a recent history of NSAID use (naproxen and ibuprofen) for approximately one week to treat a knee injury, but had discontinued these medications several days prior to symptom onset. Notably, the severe right-sided pain completely resolved approximately 15 minutes before seeking medical attention.

Initial Assessment

The patient presented with intermittent severe abdominal pain with a concerning pattern of right lower quadrant localization. The nocturnal timing and association with food intake, combined with recent NSAID use, raised suspicion for gastrointestinal pathology. The excessive salivation was noted as an unusual accompanying symptom.

The Diagnostic Journey

Initial clinical evaluation suggested the intermittent nature of pain with complete resolution between episodes pointed toward a benign etiology, possibly constipation exacerbated by recent NSAID use. However, given the localization to the right lower quadrant and severity of symptoms, further investigation was warranted. The patient was referred for urgent care evaluation.

Final Diagnosis

Following urgent care assessment, the working diagnosis was gallbladder-related pathology. The clinical presentation and examination findings suggested biliary etiology rather than the initially considered appendicitis or NSAID-induced gastropathy.

Treatment Plan

The patient was scheduled for abdominal ultrasound and additional diagnostic tests to confirm gallbladder involvement and rule out complications such as cholelithiasis or cholecystitis. Symptomatic management was initiated pending definitive diagnosis.

Outcome and Follow-up

The patient was discharged from urgent care with pending diagnostic imaging and laboratory studies. Follow-up was arranged based on ultrasound results and symptom progression. The case highlights the importance of not dismissing intermittent abdominal pain in young adults and the need for thorough evaluation when pain patterns change or localize.