Differential Diagnosis for Bilateral Lower Quadrant Abdominal Pain
Single Most Likely Diagnosis
- Appendicitis: Although appendicitis typically presents with pain initially around the umbilicus and then localizing to the right lower quadrant, it can sometimes present atypically, especially in women or when the appendix is in a retrocecal position. The presence of nausea, vomiting, and ongoing pain for 3 days supports this diagnosis.
Other Likely Diagnoses
- Gastroenteritis: Inflammation of the stomach and intestines, often due to infection, can cause diffuse abdominal pain, nausea, and vomiting. The bilateral lower quadrant pain could be due to the involvement of the intestines.
- Ovarian Cysts or Torsion: In women, ovarian cysts can cause lower abdominal pain, and if the cyst ruptures or the ovary torsions, the pain can become severe and persistent. Nausea and vomiting can also be present.
- Diverticulitis: Inflammation of the diverticula in the colon can cause lower abdominal pain, typically on the left side but can be bilateral, along with nausea and vomiting.
Do Not Miss Diagnoses
- Ectopic Pregnancy: A pregnancy that develops outside the uterus can cause severe abdominal pain, nausea, and vomiting. It is critical to consider this in women of childbearing age, as it is a life-threatening condition.
- Intestinal Obstruction: Blockage of the intestine can cause severe abdominal pain, nausea, vomiting, and can lead to serious complications if not promptly treated.
- Ruptured Abdominal Aortic Aneurysm: Although more common in older adults with risk factors, a ruptured AAA can cause severe abdominal pain and is immediately life-threatening.
Rare Diagnoses
- Inflammatory Bowel Disease (IBD) Flare: Conditions like Crohn's disease or ulcerative colitis can cause chronic abdominal pain, but a severe flare can present with acute worsening of symptoms, including nausea and vomiting.
- Endometriosis: A condition where tissue similar to the lining inside the uterus grows outside of it, leading to pain. While not typically causing acute nausea and vomiting, severe endometriosis can cause significant abdominal pain.
- Mesenteric Ischemia: Reduced blood flow to the intestines can cause severe abdominal pain, nausea, and vomiting. It is more common in older adults or those with cardiovascular disease.