Quiz: What’s causing this acute abdominal pain?

Just so you know, this is a tricky one!

A 71-year-old male with a history of cough, atrial fibrillation and hypertension presents to the emergency department with a one-day history of severe abdominal pain.

abdominal pain

On examination, his vital signs are stable. Laboratory findings reveal an expected INR of 2.8, but are otherwise unremarkable.

A palpable tender mass can be felt in the right lower quadrant of his abdomen. When the patient sits up, the location of his pain remains unchanged. A CT scan reveals the findings.

Which of the following is a risk factor for this patient’s presentation?