A 45-yr-old man comes to the emergency department because of a 6-h history of acute-onset left-sided lower abdominal pain. He describes the pain as starting over his left flank and radiating down toward his groin. The pain comes and goes but is intense when present. He has had some mild nausea without vomiting. The pain does not change with eating. The pain is less when he walks around than when he sits or lies down flat. He has not had any bloody stools, black stools, or change in bowel habits. He denies having diarrhea and constipation. He has noticed his urine looks "dark" but denies pain during urination and urinary frequency. He says that he swims several times a week for exercise, and this pain started immediately after swimming. He also notes that several days ago, his son ran into his left side while playing football. He took some acetaminophen, which minimally relieved his discomfort. He now presents for evaluation at the emergency department because the pain has not subsided. He says he has never experienced pain like this.
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