A 27-year-old man presents to the emergency department with a 2-week history of rapidly worsening right lower quadrant abdominal pain, accompanied by nausea, vomiting, and subjective fevers. He reports that his symptoms started as a dull ache but have become sharp and constant in the last few days. He has also noticed a rapidly enlarging lump in his abdomen. Furthermore, he mentions drenching night sweats and a 10-lb weight loss over the past 3 weeks. His medical history is unremarkable. He takes no medications and has no known allergies. He works as a high school basketball coach, does not smoke, and drinks alcohol only occasionally. He has no family history of malignancies.

He appears acutely ill and in distress due to abdominal pain. His temperature is 100.8 °F, his blood pressure is 110/70 mmHg, and his heart rate is 115 bpm with a respiratory rate of 18 breaths per minute. He is diaphoretic.