Yes, a ureteric stone at the pelvic brim (typically at the iliac, vessels crossing) can mimic acute appendicitis due to overlapping pain distribution. This was an applied anatomy question asked in FMGE exam and hence is discussed as a quick 2minute read.

Why Does This Happen?

    • The mid – ureter is innervated by T11-L1, which also supplies the right lower quadrant (RLQ).
    • A stone at the pelvic brim can irritable the parietal peritoneum, leading to localized pain in the RLQ. Mimicking appendicitis.
    • Associated nausea, vomiting, and guarding can further confuse the diagnosis


How to Differentiate?

Feature

Ureteric stone

 

Acute Appendicitis

Pain location

Starts in flank and radiated to Right lower quadrant

 

Starts periumbilical area and then migrates to right lower quadrant

 

Pain Nature

Colicky, intermittent

Gradual onset, steady

 

McBurney’s point Tenderness

Usually absent

Present

Psoas/ Obturator sign

Negative

Positive in retrocecal appendix

 

Hematuria

Often present

Absent

 

Fever

Unlikely

Present

 

CT scan

Stone visualized

Inflamed appendix with fat stranding

 

 

For more such interesting questions you can refer to surgery solutions in FMGE solutions book that will help you grasp subtle concepts that are not taught in regular classes or apps

Share this post -