A 33 year old indonesian male not known to have any medical illness he came complaining abdominal pain for 2 days ago. He had constipation for two days . There was no significant past surgical history.

P/E the patient appeared to be in pain and not dehydrated with a pulse rate of 75 beats/min. He was afebrile and his blood pressure was normal.

Abdominal examination revealed soft lax and tenderness in periumbilical area .

Lab WBC 12