Differential Diagnosis for Vaginal Bleeding, Cramping, and RLQ Pain in Someone with a History of Salpingectomy

Single Most Likely Diagnosis

• Ovarian cyst or torsion: Given the history of salpingectomy, which removes the fallopian tube but leaves the ovary intact, an ovarian cyst or torsion is a plausible cause for the symptoms. The RLQ pain and vaginal bleeding could be indicative of a ruptured cyst or torsion, which can cause irritation to the surrounding tissues and lead to bleeding.

Other Likely Diagnoses

• Endometriosis: Although the patient has had a salpingectomy, endometriosis can still cause symptoms like pelvic pain, cramping, and vaginal bleeding. The RLQ pain could be related to endometriotic implants in the area.
• Adhesions or scar tissue: Post-surgical adhesions from the salpingectomy could cause bowel obstruction or chronic pain, potentially leading to RLQ pain and other symptoms.
• Diverticulitis: Inflammation of the diverticula in the colon could cause RLQ pain, and if the inflammation is severe, it might lead to vaginal bleeding due to proximity and irritation of surrounding tissues.

Do Not Miss Diagnoses

• Ectopic pregnancy: Although the patient has had a salpingectomy, it's crucial to remember that ectopic pregnancies can still occur in the remaining fallopian tube or, very rarely, in the stump of the removed tube. This condition is life-threatening and must be ruled out.
• Appendicitis: Acute appendicitis can present with RLQ pain and, if ruptured, could potentially cause vaginal bleeding due to the spread of infection and inflammation.
• Ovarian cancer: While less common, ovarian cancer could present with these symptoms, especially if there's a history of genetic predisposition or other risk factors.

Rare Diagnoses

• Ureteral injury or obstruction: A complication from the previous surgery could lead to ureteral injury or obstruction, causing pain and potentially leading to secondary infections or other complications that might result in vaginal bleeding.
• Intestinal obstruction: Although rare, an intestinal obstruction could cause severe abdominal pain, including RLQ pain, and if the obstruction leads to ischemia or necrosis of the bowel, it could potentially cause vaginal bleeding due to the spread of infection.