Differential Diagnosis for Intermittently Severe Pelvic Pain
Single Most Likely Diagnosis
- Endometriosis: This condition is characterized by the growth of endometrial tissue outside the uterus, leading to pain that can be cyclic and associated with menstruation, but also intermittent and unrelated to the menstrual cycle. The description of pain feeling like "contractions" and its severity align with endometriosis, especially given the normal findings on stomach, celiac, and colonoscopy, which help rule out gastrointestinal causes.
Other Likely Diagnoses
- Adenomyosis: Similar to endometriosis, adenomyosis involves the growth of endometrial tissue into the uterine wall, leading to painful menstruation and pelvic pain. The pain can feel like contractions and is often associated with heavy menstrual bleeding.
- Ovarian Cysts: These can cause intermittent severe pelvic pain, especially if they rupture or torsion occurs. The pain can be sharp and may not always be related to the menstrual cycle.
- Pelvic Inflammatory Disease (PID): An infection of the female reproductive organs, PID can cause severe pelvic pain, fever, and other symptoms. It's a consideration, especially if there's a history of sexually transmitted infections or multiple sexual partners.
Do Not Miss Diagnoses
- Ectopic Pregnancy: Although the patient has not been pregnant before, it's crucial to rule out ectopic pregnancy, especially if there's any chance of pregnancy. The presentation of severe pelvic pain and a description of contractions could be indicative of a ruptured ectopic pregnancy, which is a medical emergency.
- Ovarian Torsion: This is a condition where the ovary twists around its ligaments, cutting off blood supply. It presents with sudden, severe pelvic pain and is a surgical emergency.
- Appendicitis: While the colonoscopy results were normal, appendicitis can still occur and presents with severe abdominal or pelvic pain, often accompanied by fever and vomiting.
Rare Diagnoses
- Leiomyosarcoma (Uterine Sarcoma): A rare type of cancer that can cause pelvic pain, among other symptoms. It's much less common than other conditions like fibroids but should be considered in the differential diagnosis due to its severity.
- Chronic Pelvic Pain Syndrome: A condition characterized by chronic pain in the pelvic region, often without an identifiable cause. It could be considered if other diagnoses are ruled out and the pain persists.