What could cause sharp pain on the left side of the abdomen that wraps around, and what should be done about it?

Sharp Left-Sided Abdominal Pain That Wraps Around

You need immediate CT imaging of your abdomen and pelvis with IV contrast to determine the cause, as this pain pattern most commonly indicates acute diverticulitis but could represent other serious conditions requiring urgent intervention. 1

Immediate Action Required

Go to the emergency department now if you have any of these accompanying symptoms: 2

• Fever or chills
• Inability to pass gas or stool
• Vomiting
• Bloody stools
• Severe tenderness when touching your abdomen
• Signs of shock (dizziness, rapid heartbeat, confusion)

Most Likely Diagnosis: Acute Diverticulitis

Sharp left lower quadrant pain that wraps around is the classic presentation of acute left-sided colonic diverticulitis, which is the most common cause of left lower quadrant pain in adults. 1 However, only about 25% of diverticulitis patients present with the classic triad of left lower quadrant pain, fever, and elevated white blood cell count, making imaging essential for accurate diagnosis. 1

Why CT Imaging Is Critical

CT abdomen and pelvis has 98% diagnostic accuracy for diverticulitis and is the gold standard imaging test. 1 The American College of Radiology designates CT as "usually appropriate" for evaluating left lower quadrant pain because it: 1

• Accurately diagnoses diverticulitis and distinguishes uncomplicated from complicated disease
• Detects alternative diagnoses that present similarly (cancer, inflammatory bowel disease, gynecologic causes)
• Guides whether you need outpatient antibiotics versus hospitalization versus surgery
• Identifies complications like abscess, perforation, or obstruction that require immediate intervention

The American College of Physicians recommends CT imaging when there is diagnostic uncertainty after initial clinical evaluation, which applies to your situation given the wrapping pain pattern. 1

Other Important Diagnoses to Consider

While diverticulitis is most likely, the wrapping pain pattern requires ruling out several other conditions:

Serious Conditions Requiring Urgent Diagnosis

Spigelian hernia can cause chronic left lower abdominal pain and carries up to 21% risk of incarceration-related complications. 3 These hernias are often inter-parietal (hidden beneath muscle layers) and difficult to detect on physical exam alone, requiring CT for diagnosis. 4, 3

Atypical appendicitis can rarely present with left lower quadrant pain, either from an unusually long appendix extending leftward or from situs inversus (reversed organ positioning). 5 Delayed diagnosis increases perforation risk and prolonged hospital stay. 5

Celiac artery aneurysm is rare but can present as sharp left-sided abdominal pain radiating to the left shoulder, and carries high mortality if ruptured. 6 CT angiography is diagnostic. 6

Other Differential Diagnoses

The American College of Radiology guidelines emphasize that CT can detect: 1, 4

• Colitis or inflammatory bowel disease
• Colon cancer (especially if you haven't had recent colonoscopy)
• Epiploic appendagitis
• Bowel obstruction
• Kidney stones or pyelonephritis
• In women: ovarian or fallopian tube pathology

What Happens After CT Diagnosis

If Uncomplicated Diverticulitis Is Found

You may be managed as an outpatient without antibiotics if you meet specific criteria: immunocompetent, no signs of systemic infection, not medically frail, and have reliable follow-up. 1 The American College of Physicians found no difference in complications, quality of life, need for surgery, or recurrence between antibiotic and non-antibiotic treatment in select patients. 1

However, antibiotics may be needed if you have: 1

• Symptoms lasting longer than 5 days
• Vomiting
• High C-reactive protein levels (>140 mg/L)
• CT findings of pericolic air, fluid collection, or extensive inflammation

If Complicated Diverticulitis Is Found

You will need hospitalization if CT shows abscess, perforation, obstruction, or significant inflammation. 1 Abscesses ≥3 cm typically require catheter drainage by interventional radiology, while free perforation requires emergency surgery. 1

If Alternative Diagnosis Is Found

Treatment depends on the specific condition identified—hernia requires surgical repair, kidney stones may need urology intervention, gynecologic pathology requires appropriate specialist referral. 4

Critical Pitfalls to Avoid

Do not assume this is "just gas" or irritable bowel syndrome without imaging first. 1 While IBS can cause left-sided colicky pain and bloating, it should only be diagnosed after structural pathology is excluded by CT. 2, 7

Do not delay imaging if symptoms persist or worsen. Predictors of progression to complicated diverticulitis include symptoms lasting >5 days, vomiting, and systemic comorbidity. 1 Early CT diagnosis can prevent hospital admission in uncomplicated cases and identify complications requiring urgent intervention. 1

Do not skip colonoscopy follow-up if you're due for colon cancer screening or if CT shows concerning features like pericolic lymph nodes or luminal mass. 1 However, routine colonoscopy is not indicated after uncomplicated diverticulitis in patients with up-to-date screening. 1

Specific Physical Exam Findings to Report

When you reach the emergency department, the physician will check for: 1, 8

• Localized left lower quadrant tenderness (most specific for diverticulitis)
• Carnett's test: whether pain worsens when you tense your abdominal muscles (suggests abdominal wall pain rather than internal organ disease)
• Rebound tenderness or guarding (suggests peritoneal irritation from perforation)
• Rovsing's sign: whether pressing on your left side causes right-sided pain (suggests appendicitis, though rare with left-sided pain)