Left Iliac Fossa Pain Flashcards
What are the surgical emergencies in a 76yo lady presenting with left iliac fossa pain?
Acute diverticulitis
Leaking AAA
Locally perforated sigmoid carcinoma
Pyelonephritis
What are the differentials in a 76yo lady with left iliac fossa pain that aren’t surgical emergencies?
Constipation IBD Ischaemic colitis Pseudomembranous colitis UTI Ureteric colic IBS Shingles Rectus sheath haematoma DKA
Pain that is initially poorly
localized, midline, and colicky but which then migrates to the LIF and becomes constant is highly suggestive of what?
Acute diverticulitis
Pain that migrates down the left flank and iliac fossa suggests what?
Migration of a ureteric stone
What does sharp iliac fossa pain suggest?
Haemorrhage, perforation or torsion
What questions should you ask with someone with LIF pain?
SOCRATES
Nausea & Vomiting - Acute diverticulitis/PID Fever Change of bowel habits Rectal bleeding Bloating - Characteristic of IBS Weight loss Gynaecological symptoms
Why are colonoscopy and double-contrast barium enema contraindicated in the acute setting of LIF pain?
Risk of perforating the acutely inflamed colon
How is acute diverticulitis managed in the acute phase?
Analgesia
Bowel rest
IV fluids
Antibiotics
Monitor
What are the main complications of diverticulitis?
Perforation
Abscess formation
Fistulation
Chronic inflammatory strictures resulting in bowel obstruction
Haemorrhage
Are colovesical fistulas more common in men or women? Why?
Men
Thought to be because the uterus sits between the sigmoid and the bladder, forming a barrier to colovesical fistula formation
What is the most common type of fistula formation caused by diverticulitis?
Colovesical
What are the main risk factors for ectopic pregnancy?
Previous ectopic pregnancy PID Tubular procedures eg sterilization Endometriosis Pelvic surgery IVF Intrauterine contraceptive device
What is Hinchey’s classification?
This classification represents an assessment of peritoneal contamination at the time of surgery in the context of acute diverticulitis
As such, it may be used as a guide to the suitability for primary anastomosis following resection
I - Pericolic or mesenteric abscess
II - Walled-off pelvic abscess
III - Generalised purulent peritonitis (~5% mortality)
IV - Generalised faecal peritonitis (~35% mortality)