Left lower quadrant abdominal pain - Revision history

Danbot: Strip excess bold

2026-03-22T09:30:02Z

Strip excess bold

← Older revision		Revision as of 09:30, 22 March 2026
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	===Must Not Miss===		===Must Not Miss===
	*~~'''~~[[Ectopic pregnancy]]~~'''~~ in reproductive-age women		*[[Ectopic pregnancy]] in reproductive-age women
	*~~'''~~[[Ovarian torsion]]~~'''~~		*[[Ovarian torsion]]
	*~~'''~~Perforated [[diverticulitis]]~~'''~~		*Perforated [[diverticulitis]]
	*~~'''~~[[Mesenteric ischemia]]~~'''~~ (especially elderly with atrial fibrillation)		*[[Mesenteric ischemia]] (especially elderly with atrial fibrillation)
	*~~'''~~Large bowel obstruction / [[volvulus]]~~'''~~ (sigmoid volvulus)		*Large bowel obstruction / [[volvulus]] (sigmoid volvulus)

	==Evaluation==		==Evaluation==
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	===Imaging===		===Imaging===
	*~~'''~~[[CT abdomen pelvis]]~~'''~~ with IV contrast: gold standard for diverticulitis, abscess, volvulus, mesenteric ischemia		*[[CT abdomen pelvis]] with IV contrast: gold standard for diverticulitis, abscess, volvulus, mesenteric ischemia
	*~~'''~~Pelvic ultrasound~~'''~~ (transvaginal): first-line for suspected ovarian torsion, ectopic pregnancy		*Pelvic ultrasound (transvaginal): first-line for suspected ovarian torsion, ectopic pregnancy
	*~~'''~~[[POCUS]]~~'''~~: free fluid, hydronephrosis, IUP identification		*[[POCUS]]: free fluid, hydronephrosis, IUP identification
	*Abdominal X-ray: useful for obstruction or volvulus (coffee bean sign in sigmoid volvulus)		*Abdominal X-ray: useful for obstruction or volvulus (coffee bean sign in sigmoid volvulus)

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	*Treat underlying disease process		*Treat underlying disease process
	*IV fluids, analgesia		*IV fluids, analgesia
	*~~'''~~[[Diverticulitis]]~~'''~~: uncomplicated — outpatient antibiotics or observation without antibiotics per recent guidelines; complicated (abscess, perforation, obstruction) — IV antibiotics, surgical consultation		*[[Diverticulitis]]: uncomplicated — outpatient antibiotics or observation without antibiotics per recent guidelines; complicated (abscess, perforation, obstruction) — IV antibiotics, surgical consultation
	*~~'''~~[[Ectopic pregnancy]]~~'''~~: emergent OB/GYN consultation		*[[Ectopic pregnancy]]: emergent OB/GYN consultation
	*~~'''~~[[Ovarian torsion]]~~'''~~: emergent GYN consultation for surgical detorsion		*[[Ovarian torsion]]: emergent GYN consultation for surgical detorsion
	*~~'''~~Sigmoid [[volvulus]]~~'''~~: GI consultation for endoscopic decompression; surgery if peritonitis		*Sigmoid [[volvulus]]: GI consultation for endoscopic decompression; surgery if peritonitis
	*~~'''~~[[Nephrolithiasis]]~~'''~~: analgesia (NSAIDs first-line), hydration		*[[Nephrolithiasis]]: analgesia (NSAIDs first-line), hydration

	==Disposition==		==Disposition==

Danbot: Expanded with EM-focused content: must-not-miss diagnoses, red flags, evaluation strategy, management, disposition

2026-03-20T23:42:44Z

Expanded with EM-focused content: must-not-miss diagnoses, red flags, evaluation strategy, management, disposition

← Older revision		Revision as of 23:42, 20 March 2026
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	~~<languages/>~~
	~~<translate>~~

	==Background==		==Background==
			*This page outlines the general approach to adult left lower quadrant (LLQ) pain
	*This page ~~describes~~ the general approach to LLQ pain in adults		*LLQ contains: sigmoid colon, descending colon, left ureter, left ovary/fallopian tube (females), left spermatic cord (males)
			*Key EM considerations: [[diverticulitis]] (most common surgical cause in adults >40), [[ovarian torsion]], [[ectopic pregnancy]], renal colic
	~~</translate>~~		*Always consider pregnancy-related emergencies in women of reproductive age
	{{Abdominal pain location}}		{{Abdominal pain location}}
	~~<translate>~~


	==Clinical Features==		==Clinical Features==
			===History===
			*Onset, character, location, radiation, aggravating/alleviating factors
			*Prior episodes of similar pain (recurrent diverticulitis)
			*Change in bowel habits, blood in stool (colitis, diverticulitis, malignancy)
			*Urinary symptoms (UTI, nephrolithiasis)
			*Menstrual/gynecologic history: LMP, vaginal bleeding/discharge, sexual activity
			*Fever (infectious/inflammatory cause)
			*Diet: low fiber (diverticular disease)
			*Age: diverticulitis more common >40 years

	*~~Left lower quadrant abdominal~~ pain		===Physical Exam===
			*LLQ tenderness, guarding, rebound (peritonitis)
			*Palpable mass (abscess, tumor)
			*CVA tenderness (pyelonephritis, nephrolithiasis)
			*Pelvic exam: cervical motion tenderness, adnexal mass/tenderness (ectopic, torsion, PID)
			*Rectal exam: stool guaiac, rectal mass
			*Testicular exam in males (referred pain from hernia or testicular pathology)

			===Red Flags===
			*Hemodynamic instability with LLQ pain + positive pregnancy test ([[ectopic pregnancy]])
			*Acute onset severe pain with no prior history (torsion, mesenteric ischemia, perforation)
			*Fever + peritoneal signs (perforation, abscess)
			*Free air on imaging (perforated diverticulitis or other hollow viscus)

	==Differential Diagnosis==		==Differential Diagnosis==
			{{DDX LLQ}}

	~~</translate>~~		===Must Not Miss===
	~~{{Template:LLQ DDX}}~~		*'''[[Ectopic pregnancy]]''' in reproductive-age women
	~~<translate>~~		*'''[[Ovarian torsion]]'''
			*'''Perforated [[diverticulitis]]'''
			*'''[[Mesenteric ischemia]]''' (especially elderly with atrial fibrillation)
			*'''Large bowel obstruction / [[volvulus]]''' (sigmoid volvulus)

	==Evaluation==		==Evaluation==
			===Laboratory===
			*[[CBC]], [[BMP]]
			*[[Urinalysis]]
			*Urine pregnancy test (mandatory in reproductive-age women)
			*[[LFTs]], lipase
			*[[Lactate]] if concern for ischemia or sepsis
			*[[CRP]]/[[ESR]] may support diverticulitis diagnosis
			*GC/CT NAAT if PID suspected

			===Imaging===
	===~~Male~~===		*'''[[CT abdomen pelvis]]''' with IV contrast: gold standard for diverticulitis, abscess, volvulus, mesenteric ischemia
			*'''Pelvic ultrasound''' (transvaginal): first-line for suspected ovarian torsion, ectopic pregnancy
	*CBC		*'''[[POCUS]]''': free fluid, hydronephrosis, IUP identification
	*Chem		*Abdominal X-ray: useful for obstruction or volvulus (coffee bean sign in sigmoid volvulus)
	*[[~~Special:MyLanguage/Urinalysis\|Urinalysis]]~~
	*?CT ~~abd/~~pelvis ~~(rule out [[Special:MyLanguage/diverticulitis\|diverticulitis~~]])
	*Testicular exam


	~~===Female===~~

	*CBC
	*Chem
	*[[Special:~~MyLanguage/Urinalysis\|Urinalysis]]~~
	*Urine pregnancy
	*?Pelvic ~~[[Special:MyLanguage/~~ultrasound~~\|ultrasound]]~~ (~~rule out [[Special~~:~~MyLanguage/~~ovarian torsion~~\|ovarian torsion]]) and/or CT abd/pelvis (rule out~~ [[~~Special:MyLanguage/diverticulitis\|diverticulitis~~]])
	*~~Pelvic exam~~


	==Management==		==Management==

	*Treat underlying disease process		*Treat underlying disease process
			*IV fluids, analgesia
			*'''[[Diverticulitis]]''': uncomplicated — outpatient antibiotics or observation without antibiotics per recent guidelines; complicated (abscess, perforation, obstruction) — IV antibiotics, surgical consultation
			*'''[[Ectopic pregnancy]]''': emergent OB/GYN consultation
			*'''[[Ovarian torsion]]''': emergent GYN consultation for surgical detorsion
			*'''Sigmoid [[volvulus]]''': GI consultation for endoscopic decompression; surgery if peritonitis
			*'''[[Nephrolithiasis]]''': analgesia (NSAIDs first-line), hydration

	==Disposition==		==Disposition==
			*Admit: complicated diverticulitis, ectopic pregnancy requiring intervention, ovarian torsion, bowel obstruction/volvulus, mesenteric ischemia
	*~~Per underlying disease process~~		*Discharge: uncomplicated diverticulitis, stable renal colic, benign ovarian cyst, with appropriate follow-up and return precautions


	==See Also==		==See Also==
			*[[Abdominal Pain]]
	*[[~~Special:MyLanguage/Abdominal Pain\|~~Abdominal Pain]]		*[[Diverticulitis]]
	*[[~~Special:MyLanguage/Abdominal Pain (Peds)\|Abdominal Pain (Peds)~~]]		*[[Ectopic pregnancy]]
			*[[Ovarian torsion]]

	==External Links==		==External Links==


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
	[[Category:Symptoms]]		[[Category:Symptoms]]
	~~</translate>~~

Ostermayer: Prepared the page for translation

2026-01-04T23:17:16Z

Prepared the page for translation

← Older revision		Revision as of 23:17, 4 January 2026
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			<languages/>
			<translate>

	==Background==		==Background==

	*This page describes the general approach to LLQ pain in adults		*This page describes the general approach to LLQ pain in adults

			</translate>
	{{Abdominal pain location}}		{{Abdominal pain location}}
			<translate>


	==Clinical Features==		==Clinical Features==

	*Left lower quadrant abdominal pain		*Left lower quadrant abdominal pain


	==Differential Diagnosis==		==Differential Diagnosis==

			</translate>
	{{Template:LLQ DDX}}		{{Template:LLQ DDX}}
			<translate>


	==Evaluation==		==Evaluation==


	===Male===		===Male===

	*CBC		*CBC
	*Chem		*Chem
	*[[Urinalysis]]		*[[Special:MyLanguage/Urinalysis\|Urinalysis]]
	*?CT abd/pelvis (rule out [[diverticulitis]])		*?CT abd/pelvis (rule out [[Special:MyLanguage/diverticulitis\|diverticulitis]])
	*Testicular exam		*Testicular exam


	===Female===		===Female===

	*CBC		*CBC
	*Chem		*Chem
	*[[Urinalysis]]		*[[Special:MyLanguage/Urinalysis\|Urinalysis]]
	*Urine pregnancy		*Urine pregnancy
	*?Pelvic [[ultrasound]] (rule out [[ovarian torsion]]) and/or CT abd/pelvis (rule out [[diverticulitis]])		*?Pelvic [[Special:MyLanguage/ultrasound\|ultrasound]] (rule out [[Special:MyLanguage/ovarian torsion\|ovarian torsion]]) and/or CT abd/pelvis (rule out [[Special:MyLanguage/diverticulitis\|diverticulitis]])
	*Pelvic exam		*Pelvic exam


	==Management==		==Management==

	*Treat underlying disease process		*Treat underlying disease process


	==Disposition==		==Disposition==

	*Per underlying disease process		*Per underlying disease process


	==See Also==		==See Also==
	*[[Abdominal Pain]]
	*[[Abdominal Pain (Peds)]]		*[[Special:MyLanguage/Abdominal Pain\|Abdominal Pain]]
			*[[Special:MyLanguage/Abdominal Pain (Peds)\|Abdominal Pain (Peds)]]


	==External Links==		==External Links==


	==References==		==References==

	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]
	[[Category:Symptoms]]		[[Category:Symptoms]]
			</translate>

Rossdonaldson1: /* Background */

2024-01-31T22:39:29Z

Background

← Older revision		Revision as of 22:39, 31 January 2024
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	==Background==		==Background==
	*This page describes the general approach to LLQ pain in adults		*This page describes the general approach to LLQ pain in adults

			{{Abdominal pain location}}

	==Clinical Features==		==Clinical Features==

Rossdonaldson1: Text replacement - " US " to " ultrasound "

2016-11-13T20:21:18Z

Text replacement - " US " to " ultrasound "

← Older revision		Revision as of 20:21, 13 November 2016
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	*[[Urinalysis]]		*[[Urinalysis]]
	*Urine pregnancy		*Urine pregnancy
	*?Pelvic US (rule out [[ovarian torsion]]) and/or CT abd/pelvis (rule out [[diverticulitis]])		*?Pelvic [[ultrasound]] (rule out [[ovarian torsion]]) and/or CT abd/pelvis (rule out [[diverticulitis]])
	*Pelvic exam		*Pelvic exam

ClaireLewis: /* References */

2016-10-29T17:06:43Z

References

← Older revision		Revision as of 17:06, 29 October 2016
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	[[Category:GI]]		[[Category:GI]]
			[[Category:Symptoms]]

Rossdonaldson1: Text replacement - "UA" to "Urinalysis"

2016-10-02T17:44:01Z

Text replacement - "*UA" to "*Urinalysis"

← Older revision		Revision as of 17:44, 2 October 2016
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	*CBC		*CBC
	*Chem		*Chem
	*UA		*[[Urinalysis]]
	*?CT abd/pelvis (rule out [[diverticulitis]])		*?CT abd/pelvis (rule out [[diverticulitis]])
	*Testicular exam		*Testicular exam
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	*CBC		*CBC
	*Chem		*Chem
	*UA		*[[Urinalysis]]
	*Urine pregnancy		*Urine pregnancy
	*?Pelvic US (rule out [[ovarian torsion]]) and/or CT abd/pelvis (rule out [[diverticulitis]])		*?Pelvic US (rule out [[ovarian torsion]]) and/or CT abd/pelvis (rule out [[diverticulitis]])

Rossdonaldson1: Text replacement - "r/o" to "rule out"

2016-07-30T16:40:54Z

Text replacement - "r/o" to "rule out"

← Older revision		Revision as of 16:40, 30 July 2016
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	*Chem		*Chem
	*UA		*UA
	*?CT abd/pelvis (~~r/o~~ [[diverticulitis]])		*?CT abd/pelvis (rule out [[diverticulitis]])
	*Testicular exam		*Testicular exam

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	*UA		*UA
	*Urine pregnancy		*Urine pregnancy
	*?Pelvic US (~~r/o~~ [[ovarian torsion]]) and/or CT abd/pelvis (~~r/o~~ [[diverticulitis]])		*?Pelvic US (rule out [[ovarian torsion]]) and/or CT abd/pelvis (rule out [[diverticulitis]])
	*Pelvic exam		*Pelvic exam

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-22T07:21:56Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 07:21, 22 July 2016
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	{{Template:LLQ DDX}}		{{Template:LLQ DDX}}

	==~~Diagnosis~~==		==Evaluation==
	===Male===		===Male===
	*CBC		*CBC

Neil.m.young: Text replacement - "==Sources==" to "==References=="

2016-06-26T20:18:13Z

Text replacement - "==Sources==" to "==References=="

← Older revision		Revision as of 20:18, 26 June 2016
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	==External Links==		==External Links==

	==~~Sources~~==		==References==
	<references/>		<references/>

	[[Category:GI]]		[[Category:GI]]