mDuke Signature Care, Durham, North Carolina; American College of Physicians. nMallinckrodt Institute of Radiology, Saint Louis, Missouri; Committee on Emergency Radiology-GSER. oUniversity of North Carolina at Chapel Hill, Chapel Hill, North Carolina. pUniversity of California San Diego, San Diego, California. qMcMaster University, Hamilton, Ontario, Canada; Commission on Nuclear Medicine and Molecular Imaging. rSpecialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Left Lower Quadrant Pain the setting of acute diverticulitis because of the risk of perforation; if indicated, it usually is deferred until the acute event has resolved. Use of Oral and Rectal Contrast Media for CT: Neither oral nor rectal contrast is required for the routine evaluation of left lower quadrant pain. More than 20 studies have found no benefit for oral contrast in the evaluation of abdominal pain in the emergency department [17]. Rectal contrast may have a limited role in evaluating for perforation after surgical intervention. OR Discussion of Procedures by Variant Variant 1: Left lower quadrant pain. Initial imaging. This variant applies if there is nonspecific pain in the left lower quadrant with a broad differential diagnosis including gastrointestinal, gynecologic, urologic, and body wall pathology. If diverticulitis is primarily suspected, please refer to Variant 2 (suspected diverticulitis) or Variant 3 (suspected complication of diverticulitis). CT Abdomen and Pelvis CT is the most useful examination for left lower quadrant pain [16,19].
Left Lower Quadrant Pain. mDuke Signature Care, Durham, North Carolina; American College of Physicians. nMallinckrodt Institute of Radiology, Saint Louis, Missouri; Committee on Emergency Radiology-GSER. oUniversity of North Carolina at Chapel Hill, Chapel Hill, North Carolina. pUniversity of California San Diego, San Diego, California. qMcMaster University, Hamilton, Ontario, Canada; Commission on Nuclear Medicine and Molecular Imaging. rSpecialty Chair, Virginia Commonwealth University Medical Center, Richmond, Virginia. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Left Lower Quadrant Pain the setting of acute diverticulitis because of the risk of perforation; if indicated, it usually is deferred until the acute event has resolved. Use of Oral and Rectal Contrast Media for CT: Neither oral nor rectal contrast is required for the routine evaluation of left lower quadrant pain. More than 20 studies have found no benefit for oral contrast in the evaluation of abdominal pain in the emergency department [17]. Rectal contrast may have a limited role in evaluating for perforation after surgical intervention. OR Discussion of Procedures by Variant Variant 1: Left lower quadrant pain. Initial imaging. This variant applies if there is nonspecific pain in the left lower quadrant with a broad differential diagnosis including gastrointestinal, gynecologic, urologic, and body wall pathology. If diverticulitis is primarily suspected, please refer to Variant 2 (suspected diverticulitis) or Variant 3 (suspected complication of diverticulitis). CT Abdomen and Pelvis CT is the most useful examination for left lower quadrant pain [16,19].