 This is a 37-year-old Caucasian female presented to ABCD General Hospital with progressively worsening suprapubic and right lower quadrant abdominal pain, which progressed throughout its course starting approximately 12 hours prior to presentation.  She admits to some nausea associated with it.  There have been no fevers, chills, and/or genitourinary symptoms.  The patient had right lower quadrant tenderness with rebound and percussion tenderness in the right lower quadrant.  She had a leukocytosis of 12.8.  She did undergo a CT of the abdomen and pelvis, which was non diagnostic for an acute appendicitis.  Given the severity of her abdominal examination and her persistence of her symptoms, we recommend the patient undergo diagnostic laparoscopy with probable need for laparoscopic appendectomy and possible open appendectomy.  The risks, benefits, complications of the procedure, she gave us informed consent to proceed.