Differential Diagnosis for Intermittent Left and Right Sided Abdominal Pain

Single Most Likely Diagnosis

• Irritable Bowel Syndrome (IBS): This is a common condition characterized by recurrent abdominal pain associated with changes in bowel habits, such as diarrhea or constipation. The intermittent nature of the pain and its location on both sides of the abdomen could align with IBS, especially if other symptoms like bloating or changes in stool consistency are present.

Other Likely Diagnoses

• Constipation: Can cause intermittent abdominal pain on both sides due to the buildup and movement of feces through the intestines.
• Gastroesophageal Reflux Disease (GERD): Although typically associated with heartburn, GERD can also cause abdominal pain that may be intermittent and located on both sides of the abdomen.
• Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause intermittent abdominal pain, often accompanied by changes in bowel habits, weight loss, and possibly blood in the stool.

Do Not Miss Diagnoses

• Appendicitis: Although appendicitis typically presents with right lower quadrant pain, it can initially cause more diffuse or intermittent pain that may not be strictly localized to one side. Missing this diagnosis can lead to perforation and severe complications.
• Ectopic Pregnancy: In women of childbearing age, ectopic pregnancy is a critical diagnosis to consider, as it can present with intermittent abdominal pain and can be life-threatening if not promptly treated.
• Ovarian Torsion: Another condition that can cause severe, intermittent pain, often on one side but potentially perceived as more diffuse, and requires urgent medical attention.
• Intestinal Obstruction: Can cause intermittent abdominal pain, vomiting, and changes in bowel habits. It is a medical emergency that requires prompt diagnosis and treatment.

Rare Diagnoses

• Intestinal Ischemia: Reduced blood flow to the intestines can cause severe, intermittent abdominal pain, often out of proportion to the physical examination findings.
• Abdominal Migraine: A condition that can cause recurrent episodes of severe, intermittent abdominal pain, often accompanied by other migraine symptoms like headache or nausea.
• Porphyrias: A group of rare genetic disorders that can cause intermittent abdominal pain, among other symptoms like neurological manifestations and psychiatric disturbances.

Each of these diagnoses should be considered in the context of the patient's full clinical presentation, including history, physical examination, and diagnostic tests as appropriate.