Rhabdomyolysis: a lesson on the perils of exercising and drinking

Acute abdomen is a common presentation to the emergency department (ED), accounting for 5% to 10% of ED visits. Of these, 10% require surgery, and 25% go undiagnosed. Usually, most of the cases of undiagnosed abdominal pain are in young women with pelvic etiologies, although occasionally, unusual causes of abdominal pain lead to diagnostic dilemmas and can have adverse clinical outcomes. We present an unusual etiology of abdominal pain in a young man, who presented with acute onset of right lower quadrant pain accompanied by nausea and vomiting. He was an amateur boxer who had recently intensified his training regimen and admitted to binge drinking for several days before presentation. The initial diagnosis was acute appendicitis, but a computed tomographic scan done revealed a normal appendix. Creatine kinase level was then checked and found to be significantly elevated, and a diagnosis of isolated abdominal wall rhabdomyolysis was made.