MASS components were migration of pain, anorexia, nausea and/or vomiting, right lower quadrant tenderness, rebound tenderness, an elevated temperature of 37.5 0 C or more, and leukocytosis (>10,000 WBCs).
According to the 1991 Center for Disease Control guidelines for the prevention and management of PID, treatment should be initiated on the basis of the following minimum clinical criteria for pelvic inflammation: lower abdominal tenderness, bilateral adnexal tenderness, or cervical motion tenderness (CMT).
Clinical investigation on admission showed lower abdominal tenderness, cervical motion tenderness, and bilateral adnexal tenderness, more prominent on the right.
However, the peculiar clinical signs of TOA are absent, such as lower abdominal tenderness, abnormal vaginal or cervical discharge, fever, abnormal vaginal bleeding, dyspareunia, cervical motion tenderness, and adnexal tenderness [18, 19].
Physical examination showed fever (temperature 39.7°C), hypotension (96/51 mm Hg), a systolic heart murmur with regular rhythm, and lower abdominal tenderness and rebound.
Physical examination revealed lower abdominal tenderness commensurate with her first menses since parturition.
Although she had bowel distension with left lower abdominal tenderness, there was no evidence of peritonitis.
Right lower quadrant tenderness and leukocytosis had two scores, and the others had one score (Table 1).
Among the MASS components, right lower quadrant tenderness was the most common, and nausea and/or vomiting was significantly related with acute appendicitis (p value 0.001).
On physical examination, the lungs were clear, the heart sounds were fast and regular, and the abdomen was soft with left lower quadrant tenderness without rebound or guarding.
