Presenting complaint:

Abdominal pain at the left lower quadrant.

History of presenting complaint:

Sudden onset of sharp pain at the left lower abdomen 3 days ago.

Associated with nausea and chills.

Examination:

Temperature 37.2 ℃.

No pallor or jaundice.

Generalized abdominaldistension with abdominal tenderness andlocalized rebound tenderness at the left lower quadrant. Bowel sounds are reduced.

No tenderness or mass on rectal examination.

Investigation:

WBC count: 11,300/μL, CRP: 9.8 mg/dL.

CT: multiple small pouches with thickened bowel walls of the sigmoid colon.

a. Crohnʼs disease

b. Sigmoid volvulus

c. Acute appendicitis

d. Sigmoid diverticulitis

e. Meckelʼs diverticulosis