A 21-year-old male is seen for the sudden onset of RLQ abdominal pain. His past medical history is notable for a right knee bleed after falling at age 1 and a blood transfusion for bleeding following a tonsillectomy at age 11.
His temperature is 36.8ºC, heart rate 110 bmp, blood pressure 105/46 mm/Hg, respiratory rate 20, and oxygen saturation 98% on room air. He is alert and in moderate pain. His HEENT, heart, lung, and neurologic exams are normal. His abdomen is soft without masses, with RLQ tenderness without rebound or guarding. There is no hepatosplenomegaly. His pain is exacerbated by active flexion of his right hip.
His WBC count is 5,300 per microliter. His hemoglobin is 11.4 g/dl with hematocrit 34%, and platelet count is 260,000 per microliter. His comprehensive metabolic panel is normal. His PT is 11.1 seconds and PTT is 95 seconds. Follow this link to the normal laboratory reference sheet.
A CT scan shows a hematoma in the right psoas muscle.
Statistically speaking, what is the most likely diagnosis?
This question appears in Med-Challenger Emergency Nurse Practitioner Exam Review with CME
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