Medical Challenge Case

Case: Microscopic Maimers

S: Patient is a 15 year-old female who complains of a stomachache and vomiting, She suffered from appendicitis less than a month ago. The doctor who saw her chose to give her a mix of antibiotics instead of surgery to remove her appendix until she had been on medications for at lest a week. Patient states that her pain started about 2 days ago. She thought it was something she ate but her friends didn't get sick that ate with her at the same restaurant. She states that she cannot be pregnant.  Review of medical records from previous physician indicated that her pelvic exam found fluid collected and she tested positive for chlamydia. She was treated with azithromycin.  

O: Vital signs normal. No fever. Abdomen felt soft. The clicks and gurgles of her bowel sounds were less frequent than normal. Tapping of the right lower abdominal quadrant produced a dull sound. Pelvic exam showed no masses and no pain upon manipulation of the uterus and palpation of the ovaries. X-rays showed no blockage in her small bowel. CT scan revealed the cause of her problem. 

A: What is your diagnosis of this patient? [Hints: Patient's immune system confined her problem to a specific area which prevented her from showing signs of fever, increased heart rate, and intense pain and the fluid caused restriction of fecal movement. The origin was not her appendix.]

P: What is your recommended plan of treatment?