Differential Diagnosis for LLQ Pain Radiating to Back in a 58-year-old Female with a History of Hysterectomy

• Single Most Likely Diagnosis
  • Diverticulitis: This condition is a common cause of lower left quadrant (LLQ) pain, especially in older adults. The pain can radiate to the back, and the patient's age and symptoms align with this diagnosis. A history of hysterectomy does not directly increase the risk for diverticulitis, but the procedure can sometimes lead to adhesions that might cause or contribute to abdominal pain, though this is less directly related to the typical presentation of diverticulitis.
• Other Likely Diagnoses
  • Kidney Stone (Nephrolithiasis): While more commonly associated with flank pain, a stone in the lower ureter can cause pain that is perceived in the LLQ and radiates to the back. The patient's gender and age are within the demographic that can experience kidney stones, though they are less common in women than in men.
  • Ovarian Cyst or Torsion: Although the patient has had a hysterectomy, if the ovaries were not removed, an ovarian cyst or torsion could cause LLQ pain radiating to the back. This is less likely if the ovaries were removed during the hysterectomy but remains a consideration if they were preserved.
  • Constipation or Bowel Obstruction: These conditions can cause significant abdominal pain that might be localized to the LLQ and could radiate to the back, especially if there is significant bowel distension or if the obstruction involves the sigmoid colon.
• Do Not Miss Diagnoses
  • Ectopic Pregnancy: Although extremely unlikely in a 58-year-old female, especially if the ovaries were removed during the hysterectomy, it's theoretically possible if the patient has an intact ovary and a fistula or other unusual anatomical anomaly. However, this would be an extraordinary circumstance.
  • Appendicitis: While appendicitis typically presents with right lower quadrant pain, it can occasionally present atypically, especially in older adults or if the appendix is in an unusual location. It's crucial not to miss this diagnosis due to its potential for severe complications.
  • Ruptured Abdominal Aortic Aneurysm (AAA): This is a life-threatening condition that can present with back pain and abdominal pain. Although more common in men, women can also have AAAs, and the risk increases with age.
• Rare Diagnoses
  • Endometriosis: If the patient has residual endometrial tissue after her hysterectomy, endometriosis could potentially cause cyclic pain, though this is less likely to be the primary cause of acute LLQ pain radiating to the back.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause chronic abdominal pain and might occasionally present with acute exacerbations of pain in the LLQ radiating to the back, though this would typically be accompanied by other symptoms like diarrhea or weight loss.
  • Neoplastic Processes: Tumors of the bowel, ovary (if present), or other abdominal structures could cause pain in the LLQ that radiates to the back, though these would typically have a more insidious onset and be accompanied by other symptoms like weight loss or changes in bowel habits.