A 22-year-old college student comes to the emergency department with a severe right lower quadrant pain. She says that the pain started approximately 6 hours ago and has progressively worsened. She has no significant medical problems and her only medication is oral contraceptive pills. She is sexually active with 1 partner, her boyfriend. Her last menstrual period was 2 weeks ago. Vital signs are: temperature 37.0 C (98.6 F), blood pressure 120/70 mm Hg, and pulse is 80/min. Abdominal examination is significant for focal tenderness in the right lower quadrant. Pelvic examination reveals exquisite tenderness in the right adnexa, a closed cervical os, and clear vaginal discharge. Laboratory studies show:
B-HCG negative
Leukocyte 7300/mm3
Hg 14g/dl
The most likely etiology of this patient's symptoms is
A. acute appendicitis
B. diverticulitis
C. ovarian torsion
D. a ruptured ectopic pregnancy
E. a tuboovarian abscess
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