A 34-year old man presents to the emergency department in excruciating abdominal pain. It woke him from sleep about one hour ago and he now has severe right lower quadrant pain radiating into his testicle. He is nauseated and has vomited twice in the past hour. The pain is not relieved in any position, and he has never experienced anything like this before. He has type 1 diabetes but claims it is well controlled. His only medication is insulin, and he has no allergies.
Physical exam:
T 37.8C, HR 108, RR 25, BP 140/83
General: weighs 75kg, in obvious distress
Abdomen: soft, bowel sounds present, right-sided tenderness worse in upper quadrant
Genitalia: uncircumcised phallus, nonbloody meatus, nontender descended testis
Rectal: normal
Think about your differential diagnosis, then reveal the options and choose the one most likely diagnosis.