A 24-Year-Old Woman With Acute Lower Abdominal Pain

A 24-year-old woman with a history of chronic right-sided sciatic pain presented to the emergency department with acute-onset periumbilical and lower abdominal pain, accompanied by nausea and vomiting. On examination, the abdomen was soft but tender in the mid to lower regions, moderately distended, with voluntary guarding. A large, soft, and compressible mass was palpated, extending to the periumbilical region. Laboratory evaluation was notable for leukocytosis.