X-Ray Quiz: A 32-Year-Old Female with Abdominal Pain

A previously fit 32-year-old woman was presented to the emergency department for left abdominal pain for two days. The pain is dull in character and is not accompanied by nausea, diarrhoea, fever, dysuria, or haematuria. She is a virgin with a regular menstrual cycle and her last menstrual period started 2 weeks ago. The physical examination revealed mild left lower quadrant tenderness only. The initial impression of her illness was urolithiasis and she underwent intramuscular piroxicam for analgesia. However, the urine analysis showed neither haematuria nor pyuria. Her pregnancy test was negative for pregnancy and hydronephrosis was not exhibited on the sonogram of her bilateral kidneys.