Left Lower Quadrant Pain

The anatomy of the LLQ, like that of the RLQ, provides a basis for recalling the causes of pain. There are fewer structures to deal with; thus, the differential diagnosis is not difficult. Visualizing the structures layer by layer, there are the skin and abdominal wall in the first layer; the sigmoid colon, omentum, and portions of small intestine in the second layer; the ureter, fallopian tubes, and ovaries (in women) in the third layer; and the aorta, pelvis, and spine beneath all these structures. Now, by using the mnemonic VINDICATE, the organs can be cross-indexed with the various etiologies that may cause pain in this area (Table 10). The following discussion emphasizes the most important diseases that must be considered in the differential diagnosis.

1. Skin and abdominal wall. Herpes zoster, cellulitis, contusion, and, especially, inguinal or femoral hernias are significant causes of LLQ pain.
2. Small intestine. Regional ileitis, intussusception, adhesion, volvulus, and other conditions that cause intestinal obstruction should be considered here.
3. Sigmoid colon. Diverticulitis, ischemic colitis, mesenteric adenitis and infarct, and granulomatous colitis are important causes. Carcinoma of the sigmoid may induce pain by perforating or obstructing the colon.
4. Ureters. Ureteral colic must be considered in the differential diagnosis of LLQ pain.
5. Ovary and fallopian tubes. A mumps oophoritis, ovarian cysts that twist on their pedicles or rupture, and small graafian follicles of the normal cycle that rupture are all included in the differential diagnosis of LLQ pain. The tubes may cause pain if there is an ectopic pregnancy, if they are inflamed by a salpingitis, or if they are infiltrated by endometriosis.
6. Aorta. Dissecting aneurysms and emboli of the terminal aorta may cause acute lower quadrant pain.
7. Pelvis and spine. Osteoarthritis, a ruptured disc, metastatic carcinoma, Pott disease, and rheumatoid spondylitis should be considered here.
8. Miscellaneous. Occasionally, pain in the bladder, prostate, or uterus is referred to the LLQ. A fibroid of the uterus may twist and cause pain. Impacted feces may cause severe pain. Referred pain from pneumonia, pleurisy, and myocardial infarction is uncommon but must be considered. Metabolic conditions that cause generalized abdominal pain and that should be remembered are listed on page 16.

Approach to the Diagnosis

There is no doubt about the value of a good history and physical examination, including both the rectal and pelvic areas. After this, the signs and symptoms should be summarized and grouped together; in many cases, this technique will pinpoint the diagnosis. The laboratory workup can now proceed. In acute cases, the physician should order a flat plate of the abdomen, CBC, urinalysis (and examine it him or herself), and serum amylase level before exploratory surgery. A pregnancy test is ordered in women of childbearing age. In chronic cases, sigmoidoscopy, barium enema, upper GI series, small-bowel follow-through, and stool examination for blood, ova, and parasites should be done before culdoscopy, peritoneoscopy, or colonoscopy is contemplated. An exploratory laparotomy remains a useful diagnostic tool even in chronic cases of LLQ pain.

Other Useful Tests

1. CT scan of the abdomen and pelvis
2. Gallium or indium scan (diverticular abscess, tuboovarian abscess)
3. Sonogram (ruptured ectopic pregnancy)
4. IVP
5. Examination of all urine for stones
6. Vaginal culture
7. Stool culture
8. Urine culture, sensitivity, and colony count
9. X-ray of lumbar spine (herniated disc, radiculopathy)
10. Peritoneal tap (ruptured ectopic pregnancy)
11. Aortogram (dissecting aneurysms)
12. Angiogram (mesenteric infarction)
13. Exploratory laparotomy

Pictures

Book Source Details

• Book Title: Differential Diagnosis in Primary Care
• Author(s): R. Douglas Collins MD, FACP
• Year of Publication: 2007
• Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Lower abdominal pain

Read excerpts from these other book chapters related to Lower abdominal pain:

Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.

More About Causes of Lower abdominal pain

• Back to symptom: Lower abdominal pain: Introduction (review 32 causes)
• Next Book Extract About Lower abdominal pain: Right Lower Quadrant Pain (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Lower abdominal pain

More About This Book: Title: Differential Diagnosis in Primary Care Authors: R. Douglas Collins MD, FACP Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 0-7817-6812-8

 » Next page: Right Lower Quadrant Pain (Differential Diagnosis in Primary Care)

Rate This Website

What do you think about the features of this website? Take our user survey and have your say:

Website User Survey

Medical Tools & Articles:

Next articles:

• Right Lower Quadrant Pain (Differential Diagnosis in Primary Care)
• Abdominal Pain (Pediatric Complaints and Diagnostic Dilemmas)
• Abdominal Pain - Case 7-1: 13-Year-Old Boy (Pediatric Complaints and Diagnostic Dilemmas)
• Abdominal Pain - Case 7-2: 5-Year-Old Girl (Pediatric Complaints and Diagnostic Dilemmas)
• Abdominal Pain - Case 7-3: 11-Year-Old Girl (Pediatric Complaints and Diagnostic Dilemmas)

Tools & Services:

• Bookmark this page
• Symptom Search
• Symptom Checker
• Medical Dictionary
• Give your feedback

Medical Articles:

• Disease & Treatments Search
• Misdiagnosis Center
• Full list of interesting articles

Forums & Message Boards

• Ask or answer a question at the Boards:
• I cannot get a diagnosis. Please help.
• Tell us your medical story.
• Share your misdiagnosis story.
• What is the best treatment for my condition?
• See all the Boards.

Enter your search terms Submit search form
Search The Web Search wrongdiagnosis.com

Common Health Mistakes

Symptom
Checker

Search Specialists by State and City