From the Guidelines
The diagnostic workup for a 22-year-old female presenting with left lower quadrant (LLQ) abdominal pain should begin with a thorough history and physical examination, followed by a CT abdomen and pelvis with IV contrast, as it is the most useful examination for LLQ pain and guides appropriate management, regardless of patient sex or body habitus 1. The initial evaluation should focus on identifying the underlying cause of the pain, which can be due to various conditions such as diverticulitis, ovarian cysts, appendicitis, or other gastrointestinal disorders.
- Initial laboratory tests should include a complete blood count to assess for infection or inflammation, comprehensive metabolic panel to evaluate organ function, urinalysis to rule out urinary tract infection, and a pregnancy test to exclude ectopic pregnancy.
- C-reactive protein or erythrocyte sedimentation rate may help identify inflammatory processes.
- The use of CT abdomen and pelvis with IV contrast is recommended as it improves the characterization and detection of bowel wall pathology, pericolic abnormalities, vascular pathology, and intraabdominal fluid collections 1.
- The CT scan can also help identify other causes of LLQ pain that may mimic diverticulitis, and its findings can guide appropriate management, including the need for surgical intervention or other treatments.
- In young women, gynecological causes must be considered, and a pelvic examination and transvaginal ultrasound may be appropriate to evaluate for ovarian pathology or other gynecological conditions.
- Common diagnoses in this demographic include irritable bowel syndrome, inflammatory bowel disease, ovarian pathology (cysts, torsion), urinary tract infection, constipation, and less commonly, diverticulitis.
- If gastrointestinal symptoms predominate, stool studies and colonoscopy might be warranted to further evaluate the cause of the pain. The most recent and highest quality study 1 supports the use of CT abdomen and pelvis with IV contrast as the initial imaging modality for evaluating LLQ pain, and its findings should guide further management and treatment.
From the Research
Diagnostic Workup for Left Lower Quadrant Abdominal Pain
The diagnostic workup for a 22-year-old female presenting with left lower quadrant (LLQ) abdominal pain may involve the following steps:
- Clinical evaluation: A thorough medical history and physical examination to identify potential causes of the pain 2
- Imaging studies:
- Computed Tomography (CT) scan: The preferred imaging modality in the emergent setting for evaluating LLQ pain, which can help diagnose conditions such as diverticulitis, colitis, and urolithiasis 3, 2
- Ultrasonography (US): Can be used to assess LLQ pain, especially in women, to evaluate for gynecologic disorders such as ovarian cysts or endometriosis 4, 5
- Magnetic Resonance Imaging (MRI): May be useful in further delineating specific anatomy, especially in cases of suspected Mullerian duct anomalies 4
- Laboratory tests: May be ordered to rule out other potential causes of abdominal pain, such as urinary tract infections or inflammatory diseases 2
Potential Causes of Left Lower Quadrant Abdominal Pain
Some potential causes of LLQ abdominal pain in a young female include:
- Gynecologic disorders: Such as endometriosis, ovarian cysts, or Mullerian duct anomalies 4, 6
- Diverticulitis: A common cause of LLQ pain, especially in older adults, but can also occur in younger individuals 5, 3
- Urolithiasis: Kidney stones can cause severe pain in the LLQ, especially if they are located in the left ureter 3
- Inflammatory diseases: Such as colitis or epiploic appendagitis, which can cause LLQ pain and may require immediate medical attention 5, 3