Lower quadrant pain

A 31-year old woman developed left lower quadrant pain after gonadotropin stimulation for IUI and a tender left inguinal mass after increasing ovarian stimulation for IVF/intracytoplasmic sperm injection. The mass was successfully removed. 

Birnbaum BA, Jeffrey RB Jr (1998) CT and sonographic evaluation of acute right lower quadrant pain. AJR Am J... 

In rare cases, dissecting or rupturing aneurysms of the retroperitoneal vessels may cause right lower quadrant pain. 

The clinical diagnosis and assessment of acute colonic diverticulitis can be difficult (Chappuis and Cohn 1988). The classic pattern of left lower quadrant pain, tenderness, fever, and leukocytosis is suggestive of acute colonic diverticulitis but can be mimicked by numerous acute abdominal conditions. Symptoms such as nausea, vomiting, constipation or diarrhoea lead to a high rate of wrong diagnosis up to 34% of cases. 

The differential diagnosis of acute diverticulitis is wide (Gritzmann et al. 2002). One important reason for left lower quadrant pain can be a torsion or necrosis of appendices epiploicae of the left colon. A well-defined point of pain is typical, and is the effect of a local peritonitis. 

It has been widely shown that ultrasound may reveal a high incidence of infectious ileocecitis in patients with acute right lower quadrant pain suspicious for appendicitis (Puylaert et al. 1988, 1989, 1997 Tarantino et al. 2003). Sonography may also reveal the features of the bowel wall useful in the differential diagnosis between infectious ileocolitis, Crohn s disease and appendicitis (Table 11.1). 

A variety of acute inflammatory conditions may affect the lower abdomen and right lower quadrant in particular prompting the patient to seek medical evaluation (de Dombal 1991). The work-up of a patient with right lower quadrant pain is based on the clinical history and physical examination, laboratory evaluation and classically plain-film... 

Kamel IR, Goldberg SN, Keogan MT, Rosen MP, Raptopoulos V (2000) Right lower quadrant pain and suspected appendicitis nonfocused appendiceal CT-review of 100 cases. Radiology 217 159-163... 

A 75-year-old woman had a double-contrast barium examination of her colon and developed severe right lower quadrant pain [21 ]. There was tenderness in the right lower abdominal quadrant with a positive McBurney s sign. The white blood cell count was 16.3 x 10 /1, with 88% neutrophils. A plain abdominal X-ray showed a densely radio-opaque tubular lesion in the right lower quadrant and CT scans showed dense barium retention in the appendix with surrounding prominent fatty infiltration. The appendix was enlarged and erythematous with a perforation near the base. 

In another case, chronic right lower quadrant pain, which persisted for 1 year after an upper gastrointestinal contrast study, was attributed to retained barium in a 47-year-old woman her appendix was mildly inflamed and the lumen was filled with barium [22 ]. 

Garcia Marin A, Martin Gil J, Pdrez Diaz MD, Bernardos Garcia L, Turdgano Fuentes F. Chronic right lower quadrant pain due to retained barium. Rev Esp Enferm Dig 2009 101(2) 151-2. 

Left lower quadrant abdominal pain is often brought on or made worse by eating. Passage of stool or flatus may provide some relief. 

Left or right lower quadrant abdominal pain and cramps that are relieved by passage of diarrhea... 

WR is a 37-year-old native of India and a permanent resident in the United States who has recently returned from a trip to Calcutta, India where he was visiting a relative. He presents in the emergency department with complaints of a 3-week history of sharp, crampy, and postprandial abdominal pain. The pain is more intense over the right lower quadrant, and associated with watery nonbloody diarrhea and tenesmus. 

Intermittent periumbilical or lower right quadrant pain with cramps and audible bowel sounds is characteristic of small intestinal disease. 

Diagnosis is based on clinical symptoms that include periumbilical or right lower quadrant (RLQ) pain, vomiting, nausea, fever and leucocytosis. Nevertheless, more than 30% of cases of appendicitis have atypical clinical presentations (Lewis et al. 1975), particularly in small children and in cases of unusual appendiceal location (Rothrock et al. 1991 Poole 1990). In addition, the presentation signs and symptoms of many nonsurgical condi-... 

Patient complaints include loss of appetite, vomiting, abdominal pain, obstipation, G1 bleeding or a palpable mass in the right lower quadrant. 

Clinical symptoms are related to those caused by a varying severity of bowel obstruction with recurrent abdominal pain and a palpable right lower quadrant mass. 

The clinical assessment of the painful right lower quadrant is still the cornerstone in the diagnosis of... 

---