17. Left Iliac Fossa Pain

Question 1

What are the main differentials for LIF pain in a 76yo female?

Answer 1

Acute diverticulitis, constipation, IBD, ischaemic colitis, leaking AAA, pseudomembranous colitis, locally perforated sigmoid carcinoma

Question 2

What does poorly localised pain the migrates to the LIF suggest?

Answer 2

Acute diverticulitis

Question 3

After characterising the LIF pain what other symptoms should you ask about?

Answer 3

Nausea and vomiting
Fever
Change of bowel habit
Rectal bleeding
Bloating
Weight Loss
Gynaecological problems

Question 4

What examinations are important to consider in someone with LIF pain?

Answer 4

Abdo exam, DRE and vaginal examination

Question 5

How would you manage diverticulitis in the acute phase?

Answer 5

Analgesia, bowel rest, IV fluid, antibiotics, VTE prophylaxis and monitor

Question 6

What may be offered 2-6 weeks after resolution of acute diverticulitis?

Answer 6

Colonoscopy to confirm the diagnosis and assess the extent of diverticulosis and exclude cancer