Learning objectives
Discussing the pathologies that can result in left lower quadrent pain
Learning computed tomography findings of appendigitis eppiploica,
sigmoid diverticulitis,
ureterolithiasis,
ovarian cyst rupture and iliac muscle abscess.
Background
Left lower abdominal quadrant contains sigmoid colon,
sigmoid mesentery,
left ureter, lower pole of left kidney,
left ovary and its vasculature at women,
ilopsoas muscle in addition to the retroperitoneal and intraperitoneal spaces and iliac artery and vein.
Despite left lower quadrant pain is not very common; it can be caused by any pathologies of these anatomical structures.
Appendigitis eppiploica,
sigmoid divetriculitis,
ureterolitiasis,
ovarian cyst rupture and abscess of iliacus muscle are some of the pathologies that may resuly in LLQP.
Appendigitis eppiploica (AE) is...
Findings and procedure details
In the presented case 31 years-old male presented with LLQP admitted to emercency service.
He had high serum CRP levels and leucocytosis at that time.
On his intavenous contrast enhanced abdominal CT there was a lobulated noduler fatty tissue on the anti-mesenteric anterior surface of the sigmoid colon. Surrounding mesenteric fat had striations.
And the lobulated fat had a central hyperdens dot sign which is specific finding for AE.
There was also a bowel wall thickening at that level (Figure1).
A seventy five years old...
Conclusion
Appendigitis epiploica,
sigmoid divetriculitis,
ureterolitiasis,
ovarian cyst rupture and abscess of iliacus muscle are some of the pathologies that should be looked for at CT ies of patients with LLQP.
Especially mesenteric and paracolic fat tissue evaluation is very important at these patients since striation of these area can be a finding of both EA and diverticulitis(1,3).
Computed tomography is very valuable in the work-up of patients with left lower quadrant pain for differentiating pelvic,
intestinal,
urological and retroperitoneal pathologies.
References
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