Causes of Left Lower Quadrant Abdominal Pain
Acute diverticulitis of the sigmoid or descending colon is the most common cause of left lower quadrant pain in adults, but a broad differential diagnosis must be considered including colitis, inflammatory bowel disease, epiploic appendagitis, bowel obstruction, hernia, ovarian and fallopian tube pathology, pyelonephritis, and urolithiasis. 1
Primary Gastrointestinal Causes
Diverticular Disease (Most Common)
- Acute diverticulitis is the leading cause of left lower quadrant pain, with prevalence rising significantly—a 50% increase in events between 2000 and 2007 1
- Approximately 10% of the Western population has diverticulosis at age 40, increasing to 70% or more in older patients 1
- Between 5% and 25% of patients with diverticulosis will develop diverticulitis 1
- The classic triad of left lower quadrant pain, fever, and leukocytosis is present in only approximately 25% of diverticulitis cases 1
- Misdiagnosis based on clinical assessment alone occurs in 34% to 68% of cases 1
Other Colonic Pathology
- Colitis (infectious, ischemic, or inflammatory) presents with overlapping symptoms to diverticulitis 1, 2
- Inflammatory bowel disease (Crohn's disease or ulcerative colitis) 1
- Epiploic appendagitis—a benign self-limited condition that should be recognized to avoid unnecessary surgery 1, 3
- Fecal impaction 2
- Perforated colon cancer—colonoscopy is indicated after diverticulitis if abnormal pericolic lymph nodes or luminal mass is present 1, 4
Small Bowel Pathology
- Bowel obstruction 1
Urologic Causes
- Urolithiasis (left-sided kidney stones) 1, 2
- Pyelonephritis (left kidney infection) 1
- Urinary tract infection 4
Gynecologic Causes (in Females)
- Ovarian pathology (cysts, torsion, masses) 1
- Fallopian tube pathology (ectopic pregnancy, pelvic inflammatory disease) 1, 5
- Adnexal torsion 5
Abdominal Wall and Musculoskeletal
- Hernia (inguinal, femoral, or incisional) 1
- Abdominal wall pain 5
- Iliopsoas syndrome—often undetected and diagnosed by sonopalpation 3
- Rectus sheath hematoma (spontaneous hemorrhage) 2
Vascular Causes
- Spontaneous retroperitoneal hemorrhage 2
Important Clinical Pitfalls
Age-Related Considerations
- In older patients, early diagnosis is critical due to higher rates of comorbid disease-related complications 1
- Symptoms and clinical findings may be nonspecific in elderly patients, with atypical presentations of common diseases 1
Gender-Specific Evaluation
- In premenopausal females, gynecologic and nongynecologic pathology may present with identical clinical pictures, requiring consideration of both 1
- Pregnancy testing is essential in women of reproductive age 5
Diagnostic Accuracy Limitations
- Clinical assessment alone is unreliable—misdiagnosis rates are unacceptably high at 34% to 68% for diverticulitis 1
- Many conditions present with overlapping symptoms that mimic acute diverticulitis 1
Extra-Abdominal Causes
- Respiratory infections and other extra-abdominal causes should not be overlooked 5