Differential Diagnosis for RLQ Pain in a 2-Month Postpartum Patient
Single Most Likely Diagnosis
- Ovarian cyst or torsion: This condition is a common cause of right lower quadrant (RLQ) pain in postpartum women, especially considering the increased risk of ovarian torsion due to the physiological changes during pregnancy and postpartum period.
Other Likely Diagnoses
- Appendicitis: Although less common in the postpartum period, appendicitis remains a significant consideration for RLQ pain and requires prompt evaluation.
- Constipation or bowel obstruction: Postpartum women may experience constipation due to hormonal changes, pain medications, or decreased mobility, which can cause RLQ pain.
- Uterine infection or endometritis: Although more commonly associated with lower abdominal pain, uterine infections can sometimes present with localized pain, including in the RLQ.
- Hernia: Incisional hernias can occur at the site of a cesarean section scar, potentially causing RLQ pain if the hernia becomes incarcerated or strangulated.
Do Not Miss Diagnoses
- Ectopic pregnancy: Although rare at 2 months postpartum, an ectopic pregnancy can be life-threatening and must be considered, especially if there's a possibility of a new pregnancy.
- Ruptured ovarian cyst: A ruptured ovarian cyst can lead to severe intra-abdominal bleeding and requires immediate medical attention.
- Intestinal ischemia: This condition, which can result from a thromboembolic event or venous thrombosis, is rare but potentially fatal if not promptly diagnosed and treated.
- Pulmonary embolism: While typically presenting with respiratory symptoms, a pulmonary embolism can sometimes cause referred abdominal pain, including in the RLQ, and is a critical diagnosis not to miss in the postpartum period due to the increased risk of thromboembolic events.
Rare Diagnoses
- Diverticulitis: Although more common in older populations, diverticulitis can occur in younger individuals and should be considered in the differential diagnosis of RLQ pain.
- Inflammatory bowel disease (IBD) flare: Conditions like Crohn's disease or ulcerative colitis can cause RLQ pain and may have their first presentation or a flare during the postpartum period.
- Primary peritonitis: A rare condition that can occur in the absence of an obvious source of infection, primary peritonitis requires a high index of suspicion for diagnosis.
- Mesenteric adenitis: This condition, often related to viral infections, can mimic appendicitis and other causes of RLQ pain but is less common in adults.