title: A case of Hickam's dictum: concurrent appendicitis and ectopic pregnancy.
abstract: BACKGROUND
  Both ectopic pregnancy and appendicitis are surgical emergencies that should be considered in female patients who present with right lower-quadrant pain. Deciding on the appropriate imaging modality in the pregnant patient can be difficult. The challenge of diagnosis is compounded when one considers that both pathologies may be present simultaneously.
  
  
  OBJECTIVE
  We present a case demonstrating co-occurrence of ectopic pregnancy and appendicitis and suggest an algorithm for evaluation and management of cases with this presentation.
  
  
  METHODS
  A 25-year-old woman presented to the Emergency Department complaining of 3 days of abdominal pain and a positive urine pregnancy test. After consultation with Obstetrics/Gynecology (OB/GYN) and General Surgery, a nondiagnostic pelvic ultrasound (US), and a magnetic resonance imaging (MRI) study consistent with appendiceal inflammation, the patient was taken to the operating room for a laparoscopic appendectomy. While removing the inflamed appendix, the general surgeon noted the right fallopian tube was enlarged, suggestive of an ectopic pregnancy. OB/GYN was consulted again intraoperatively and noted a right ectopic pregnancy. The surgical intervention was completed with a right salpingectomy.
  
  
  CONCLUSIONS
  In a pregnant patient with right lower-quadrant pain, the differential diagnosis includes ectopic pregnancy, acute appendicitis, or in rare cases, both.
authors.affiliation: MedStar Georgetown University Hospital, Washington, DC; MedStar Washington Hospital Center, Washington, DC.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Pate
authors.forename: Dana
authors.initials: D
authors.lastname: Kindermann
authors.forename: Kori
authors.initials: K
authors.lastname: Hudson
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D001064:Appendicitis / Q000150:complications* / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000175:diagnosis*
keywords: appendicitis; ectopic pregnancy