It is accurate and guides appropriate management, regardless of patient sex or patient body habitus [20]. CT is sensitive for small quantities of extraluminal intraperitoneal or retroperitoneal air [21,22]. Extraluminal air can be a critical finding indicating luminal perforation and often has surgical implications. Colonic diverticulitis is a common cause of small-volume extraluminal air at CT. Large-volume extraperitoneal air is more commonly seen with peptic ulcer disease or anastomotic dehiscence but can indicate a large-caliber perforation from diverticulitis [21]. Mortality rates are higher in patients with larger amounts of extraluminal air [21]. Fluoroscopic Contrast-Enhanced Enema Contrast-enhanced enema is not generally useful as the initial imaging test in patients with left lower quadrant pain. Although it may hold some utility in sigmoid and small bowel pathology, contrast enema would be of little value in the work up of other potential etiologies of left lower quadrant pain including gynecologic or urologic conditions. No recent studies in the utility of fluoroscopic contrast-enhanced enema and left lower quadrant pain have been published. Left Lower Quadrant Pain MRI Abdomen and Pelvis MRI is not useful for the initial evaluation of acute abdominal pain [1,12]. It is less sensitive for extraluminal air and urinary tract calculi, is more time-consuming to perform, requires an active screening process for indwelling devices and metal, and is more subject to motion artifacts in symptomatic patients. Few have compared the diagnostic accuracy of CT and MRI for the evaluation of left lower quadrant pain. In a 2013 pilot study, 30 consecutive patients with either sigmoid colon cancer (n = 15) or recent treatment for acute diverticulitis (n = 15) were imaged with CT or unenhanced MRI (T2-weighted and diffusion-weighted imaging) [12].
Left Lower Quadrant Pain. It is accurate and guides appropriate management, regardless of patient sex or patient body habitus [20]. CT is sensitive for small quantities of extraluminal intraperitoneal or retroperitoneal air [21,22]. Extraluminal air can be a critical finding indicating luminal perforation and often has surgical implications. Colonic diverticulitis is a common cause of small-volume extraluminal air at CT. Large-volume extraperitoneal air is more commonly seen with peptic ulcer disease or anastomotic dehiscence but can indicate a large-caliber perforation from diverticulitis [21]. Mortality rates are higher in patients with larger amounts of extraluminal air [21]. Fluoroscopic Contrast-Enhanced Enema Contrast-enhanced enema is not generally useful as the initial imaging test in patients with left lower quadrant pain. Although it may hold some utility in sigmoid and small bowel pathology, contrast enema would be of little value in the work up of other potential etiologies of left lower quadrant pain including gynecologic or urologic conditions. No recent studies in the utility of fluoroscopic contrast-enhanced enema and left lower quadrant pain have been published. Left Lower Quadrant Pain MRI Abdomen and Pelvis MRI is not useful for the initial evaluation of acute abdominal pain [1,12]. It is less sensitive for extraluminal air and urinary tract calculi, is more time-consuming to perform, requires an active screening process for indwelling devices and metal, and is more subject to motion artifacts in symptomatic patients. Few have compared the diagnostic accuracy of CT and MRI for the evaluation of left lower quadrant pain. In a 2013 pilot study, 30 consecutive patients with either sigmoid colon cancer (n = 15) or recent treatment for acute diverticulitis (n = 15) were imaged with CT or unenhanced MRI (T2-weighted and diffusion-weighted imaging) [12].