Notes

A 59-year-old female with a past medical history significant for seizure disorder on Topamax, chronic pancreatitis, stage 2 breast cancer in remission status post lumpectomy, and recent episode of descending and sigmoid colitis presented to the hospital with persistent right-sided flank pain. She had recently been discharged from an outside facility where CT imaging on March 25, 2026 demonstrated long-segment colitis without abscess, for which she completed a course of Flagyl and Bactrim. She returned with 3–4 days of worsening right flank pain radiating anteriorly, exacerbated by movement and positional changes, without associated fever, chills, gastrointestinal bleeding, urinary symptoms, or bowel habit changes. Initial evaluation included repeat CT abdomen and pelvis as well as CTA imaging, both of which were unremarkable for acute intra-abdominal pathology. Urinalysis was normal. Gastroenterology and Urology consultations were obtained; both services agreed there was no evidence of ongoing colitis, intra-abdominal pathology, or genitourinary source. Physical examination was notable for focal tenderness in the right flank region with a pain pattern suggestive of musculoskeletal or possible nerve-related etiology rather than visceral pathology. Laboratory evaluation revealed mild leukocytosis without clear infectious source. Imaging and clinical findings were overall inconsistent with recurrence of prior colitis, particularly given the prior disease was left-sided and her current symptoms were right-sided.

During hospitalization, the patient was managed conservatively with analgesics and muscle relaxants with gradual improvement in symptoms. No further antibiotics were initiated as there was no evidence of ongoing infection or intra-abdominal inflammatory process. Serial abdominal examinations remained benign, and the patient did not develop any red flag symptoms. Leukocytosis was trended and remained clinically stable without progression. Her chronic conditions including seizure disorder were managed with continuation of home medications. DVT prophylaxis was provided during hospitalization. Given improvement in pain control, stability of vital signs, and absence of concerning findings on imaging or specialist evaluations, the patient was deemed stable for discharge with a working diagnosis of musculoskeletal versus radicular flank pain. She was discharged with recommendations for continued use of analgesics and muscle relaxants as needed, activity modification, and close outpatient follow-up with her primary care physician, with consideration for further outpatient evaluation if symptoms persist or worsen. Patient was discharged in stable and improved condition with instructions for outpatient follow up.