From the Research
Left lower quadrant (LLQ) abdominal examination after colonoscopy should focus on assessing for potential complications, with severe, persistent, or worsening pain in the LLQ warranting immediate medical attention as it may indicate perforation or other complications, as highlighted in a recent study 1. When examining the LLQ after colonoscopy, look for tenderness, guarding, rebound tenderness, or distension. Fever, severe abdominal pain, rigid abdomen, rectal bleeding beyond minor spotting, or inability to pass gas are concerning signs requiring prompt evaluation. Some key points to consider when evaluating LLQ pain after colonoscopy include:
- The LLQ contains the descending and sigmoid colon, which are common sites for diverticular disease and are at risk for perforation during colonoscopy, with a study from 2 noting that sigmoid colon was the predominant site of perforation.
- Perforation occurs in approximately 0.1% of diagnostic colonoscopies and up to 0.3% of therapeutic procedures, as reported in 1.
- Post-colonoscopy LLQ pain may also result from stretching of the bowel wall during the procedure, transient inflammation, or exacerbation of pre-existing conditions like diverticulitis or irritable bowel syndrome. The management of colonoscopic perforations depends on various factors, including the size, severity, and location of the perforation, as well as the patient's overall health status, with a study from 2 noting that surgical intervention was employed in 75% of patients with colonoscopic perforations. In terms of antibiotic prophylaxis, a study from 3 recommended the use of ceftriaxone and metronidazole for elective colon surgery, as it was associated with a decreased rate of surgical site infections compared to other antibiotic regimens. It is essential to prioritize the patient's safety and well-being, and to seek immediate medical attention if any concerning signs or symptoms are present, as emphasized in 1.