Mittelschmerz
This is the pain associated with ovulation - for many years it was thought to be post-ovulatory but recently it has been demonstrated as a pre-ovulatory finding. It may cause right iliac fossa pain. Characteristically, the pain occurs at the mid-point of the menstrual cycle and often there is a history of recurrent right abdominal pain.
This physiological condition may present similarly to acute appendicitis and always should be included in the differential of appendicitis if presentation is in a menstruating female. Features that help to discriminate it include:
- fever rare; however, leukocytosis can occur
- pain settles quickly
Reference
- Brott N. Mittelschmerz. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.2023 May 1.
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