Right Lower Quadrant (RLQ) Pain: Beyond The Boundaries Of Appendicitis
Right Lower Quadrant(RLQ) Pain: Beyond the boundaries of appendicitis
DOI:
https://doi.org/10.70284/njirm.v6i5.983Keywords:
Right lower quadrant pain, MDCT, appendicitis, ileo-cecal tuberculosisAbstract
Right lower quadrant abdominal pain (RLQP) is one of the commonest causes for surgical emergencies. Beyond appendicitis and ileocecal (IC) tuberculosis; right iliac fossa pain indicates a varied list of differential diagnoses thus posing a challenge to surgeons. Causes of RLQP other than appendicitis and IC tuberculosis include inflammatory and infectious conditions involving the ileocecal region; diverticulitis; malignancies; pelvic cystic pathologies in women and miscellaneous conditions affecting omentum and mesentery. Multidetector computed tomography (MDCT) has seen a quantum leap since its introduction for bowel pathology and is now the modality of choice for evaluation of patients with right lower quadrant pain. MDCT is an extremely useful noninvasive method for diagnosis and management of not only the most common causes such as appendicitis, but also less common conditions.[Goel N NJIRM 2015; 6(5):125-133]
References
1. Postier RG, Squires RA. Acute abdomen. In:
Townsend CM Jr., ed. Sabiston textbook of
surgery: the biological basis of modern surgical
practice. 18th ed. Philadelphia, Pa: Saunders,
2007; 1180–1198.
2. Ahn SH, Mayo-Smith WW, Murphy BL, Reinert
SE, Cronan JJ. Acute nontraumatic abdominal
pain in adult patients: abdominal radiography
compared with CT evaluation. Radiology 2002;
225(1):159–164.
3. Johnson PT, Horton KM, Mahesh M, Fishman EK.
Multidetector computed tomography for
suspected appendicitis: multi-institutional
survey of 16-MDCT data acquisition protocolsand review of pertinent literature. J Comput Assist Tomogr 2006;30(5):758–764
4. Maher MM, Kalra MK, Sahani DV, et al. Techniques, clinical applications and limitations of 3D reconstruction in CT of the abdomen. Korean J Radiol 2004;5(1):55–67
5. Macari M, Balthazar EJ. The acute right lower quadrant: CT evaluation. Radiol Clin North Am 2003; 41(6):1117–1136.
6. O'Malley ME, Halpern E, Mueller PR, Gazelle GS. Helical CT protocols for the abdomen and pelvis: a survey. AJR Am J Roentgenol 2000; 175(1):109–113.
7. American College of Radiology. Right lower quadrant pain. ACR practice guideline. http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonGastrointestinalImaging/RightLowerQuadrantpainDoc12.aspx. Accessed October 25, 2010
8. Ganguli S, Raptopoulos V, Komlos F, Siewert B, Kruskal JB. Right lower quadrant pain: value of the nonvisualized appendix in patients at multidetector CT. Radiology 2006;241(1):175–180
9. Singh AK, Gervais DA, Hahn PF, Sagar P, Mueller PR, Novelline RA. Acute epiploic appendagitis and its mimics. RadioGraphics 2005; 25(6):1521–1534.
10. Wilson EB. Surgical evaluation of appendicitis in the new era of radiographic imaging. Semin US, CT, MRI 2003; 24:65-68
11. Jacobs JE, Birnbaum BA, Macari M, et al. Acute appendicitis: comparison of helical CT diagnosis—focused technique with oral contrast material versus nonfocused technique with oral and intravenous contrast material. Radiology 2001; 220:683-690
12. Balthazar EJ, Birnbaum BA, Yee J, et al. Acute appendicitis: CT and US correlation in 100 patients. Radiology 1994; 190:31-35 [Medline]
13. Pickuth D, Heywang-Kobrunner SH, Spielmann RP. Suspected appendicitis: is ultrasonography or computed tomography the preferred imaging technique? Eur J Surg 2000; 166:315-319
14. Leder RA, Low VH. Tuberculosis of the abdomen. Radiol Clin North Am 1995; 33:691-705.
15. Balthazar EJ, Gordon R, Hulnick D. Ileocecal tuberculosis: CT and radiologic evaluation. AJR Am J Roentgenol 1990; 154:499-503.
16. Horton KM, Corl FM, Fishman EK. CT evaluation of the colon: inflammatory disease. RadioGraphics 2000; 20(2):399–418.
17. Frick MP, Maile CW, Crass JR, Goldberg ME, Delaney JP. Computed tomography of neutropenic colitis. AJR Am J Roentgenol 1984;143(4):763–765
18. Merine DS, Fishman EK, Jones B, Nussbaum AR, Simmons T. Right lower quadrant pain in the immunocompromised patient: CT findings in 10 cases. AJR Am J Roentgenol 1987; 149(6):1177–1179.
19. Helper DJ. Medical management of Crohn's disease: a guide for radiologists. Eur J Radiol 2009; 69(3):371–374.
20. Horton KM, Corl FM, Fishman EK. CT evaluation of the colon: inflammatory disease. RadioGraphics 2000; 20(2):399–418
21. Hara AK,Swartz PG. CT enterography of Crohn's disease. Abdom Imaging 2009; 34(3):289–295.
22. American College of Radiology. Imaging recommendations for patients with Crohn's disease. ACR Appropriateness Criteria. http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonGastrointestinalimaging/CrohnsDiseaseDoc5.aspx. Accessed October 25, 2010.
23. Puylaert JB, Van der Zant FM, Mutsaers JA. Infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella: clinical, radiological and US findings. Eur Radiol 1997; 7(1):3–9.
24. Leschka S,Alkadhi H,Wildermuth S, Marincek B. Multi-detector computed tomography of acute abdomen. Eur Radiol 2005;15(12):2435–2447
25. Fry RD,Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM Jr., ed. Sabiston textbook of surgery: the biological basis of modern surgical practice. 18th ed. Philadelphia, Pa: Saunders, 2007; 1348–1432.
26. Katz DS, Lane MJ, Ross BA, Gold BM,Jeffrey RB Jr., Mindelzun RE. Diverticulitis of the right colon revisited. AJR Am J Roentgenol 1998;171(1):151–156
27. Jang HJ, Lim HK, Lee SJ, Lee WJ, Kim EY, Kim SH. Acute diverticulitis of the cecum and ascending colon: the value of thin-section helical CT findings in excluding colonic carcinoma. AJR Am J Roentgenol 2000; 174(5):1397–1402.28. Chintapalli KN, Chopra S, Ghiatas AA, Esola CC, Fields SF, Dodd GD 3rd. Diverticulitis versus colon cancer: differentiation with helical CT findings. Radiology 1999; 210(2):429–435.
29. Greenstein S, Jones B, Fishman EK, Cameron JL, Siegelman SS. Small-bowel diverticulitis: CT findings. AJR Am J Roentgenol 1986; 147(2):271–274.
30. Krummen DM, Camp LA, Jackson CE. Perforation of terminal ileum diverticulitis: a case report and literature review. Am Surg 1996; 62(11):939–940.
31. Dupre MP, Jadavji I, Matshes E, Urbanski SJ. Diverticular disease of the vermiform appendix: a diagnostic clue to underlying appendiceal neoplasm. Hum Pathol 2008; 39(12):1823–1826.
32. Lee KH, Lee HS, Park SH, et al. Appendiceal diverticulitis: diagnosis and differentiation from usual acute appendicitis using computed tomography. J Comput Assist Tomogr 2007; 31(5):763–769.
33. Hoeffel C, Crema MD, Belkacem A, et al. Multi-detector row CT: spectrum of diseases involving the ileocecal area. RadioGraphics 2006; 26(5):1373–1390.
34. Matsushita M, Hajiro K, Kajiyama T, et al. Malignant lymphoma in the ileocecal region causing intussusception. J Gastroenterol 1994; 29(2):203–207.
35. Macari M, Hines J, Balthazar E, Megibow A. Mesenteric adenitis: CT diagnosis of primary versus secondary causes, incidence, and clinical significance in pediatric and adult patients. AJR Am J Roentgenol 2002; 178(4):853–858.
36. Rao PM, Rhea JT, Novelline RA. CT diagnosis of mesenteric adenitis. Radiology 1997; 202(1):145–149.
37. van Breda Vriesman AC, Lohle PN, Coerkamp EG,Puylaert JB. Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history. Eur Radiol 1999; 9(9):1886–1892.
38. Puylaert JB. Right-sided segmental infarction of the omentum: clinical, US, and CT findings. Radiology 1992; 185(1):169–172.
39. Uncu H, Taner D. Appendiceal endometriosis: two case reports. Arch Gynecol Obstet 2008; 278(3):273–275.
40. Sheikh HA, Krishnamurti U,Bhat Y, Rajendiran SA. 42-year-old woman with a 7-month history of abdominal pain. A, endometriosis involving
ileocecal junction and 2 pericolonic lymph nodes; B, intranodal benign glandular inclusions. Arch Pathol Lab Med 2005; 129(12):e218–e221.
41. Horton KM, Fishman EK. MDCT and 3D imaging in transient enteroenteric intussusception: clinical observations and review of the literature. AJR Am J Roentgenol 2008; 191(3):736–742.
42. Tejler G, Jiborn H. Volvulus of the cecum: report of 26 cases and review of the literature. Dis Colon Rectum 1988; 31(6):445–449.
43. Khurana B. The whirl sign. Radiology 2003; 226(1):69–70.
44. Balthazar EJ, Yen BC, Gordon RB. Ischemic colitis: CT evaluation of 54 cases. Radiology 1999; 211(2):381–388.
45. Horton KM, Fishman EK. Multi-detector row CT of mesenteric ischemia: can it be done? RadioGraphics 2001; 21(6):1463–1473.
46. Kiran Jain, Imaging of peritoneal inclusion cysts, American Journal of Roentgenology. 2000;174: 1559-1563.
Townsend CM Jr., ed. Sabiston textbook of
surgery: the biological basis of modern surgical
practice. 18th ed. Philadelphia, Pa: Saunders,
2007; 1180–1198.
2. Ahn SH, Mayo-Smith WW, Murphy BL, Reinert
SE, Cronan JJ. Acute nontraumatic abdominal
pain in adult patients: abdominal radiography
compared with CT evaluation. Radiology 2002;
225(1):159–164.
3. Johnson PT, Horton KM, Mahesh M, Fishman EK.
Multidetector computed tomography for
suspected appendicitis: multi-institutional
survey of 16-MDCT data acquisition protocolsand review of pertinent literature. J Comput Assist Tomogr 2006;30(5):758–764
4. Maher MM, Kalra MK, Sahani DV, et al. Techniques, clinical applications and limitations of 3D reconstruction in CT of the abdomen. Korean J Radiol 2004;5(1):55–67
5. Macari M, Balthazar EJ. The acute right lower quadrant: CT evaluation. Radiol Clin North Am 2003; 41(6):1117–1136.
6. O'Malley ME, Halpern E, Mueller PR, Gazelle GS. Helical CT protocols for the abdomen and pelvis: a survey. AJR Am J Roentgenol 2000; 175(1):109–113.
7. American College of Radiology. Right lower quadrant pain. ACR practice guideline. http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonGastrointestinalImaging/RightLowerQuadrantpainDoc12.aspx. Accessed October 25, 2010
8. Ganguli S, Raptopoulos V, Komlos F, Siewert B, Kruskal JB. Right lower quadrant pain: value of the nonvisualized appendix in patients at multidetector CT. Radiology 2006;241(1):175–180
9. Singh AK, Gervais DA, Hahn PF, Sagar P, Mueller PR, Novelline RA. Acute epiploic appendagitis and its mimics. RadioGraphics 2005; 25(6):1521–1534.
10. Wilson EB. Surgical evaluation of appendicitis in the new era of radiographic imaging. Semin US, CT, MRI 2003; 24:65-68
11. Jacobs JE, Birnbaum BA, Macari M, et al. Acute appendicitis: comparison of helical CT diagnosis—focused technique with oral contrast material versus nonfocused technique with oral and intravenous contrast material. Radiology 2001; 220:683-690
12. Balthazar EJ, Birnbaum BA, Yee J, et al. Acute appendicitis: CT and US correlation in 100 patients. Radiology 1994; 190:31-35 [Medline]
13. Pickuth D, Heywang-Kobrunner SH, Spielmann RP. Suspected appendicitis: is ultrasonography or computed tomography the preferred imaging technique? Eur J Surg 2000; 166:315-319
14. Leder RA, Low VH. Tuberculosis of the abdomen. Radiol Clin North Am 1995; 33:691-705.
15. Balthazar EJ, Gordon R, Hulnick D. Ileocecal tuberculosis: CT and radiologic evaluation. AJR Am J Roentgenol 1990; 154:499-503.
16. Horton KM, Corl FM, Fishman EK. CT evaluation of the colon: inflammatory disease. RadioGraphics 2000; 20(2):399–418.
17. Frick MP, Maile CW, Crass JR, Goldberg ME, Delaney JP. Computed tomography of neutropenic colitis. AJR Am J Roentgenol 1984;143(4):763–765
18. Merine DS, Fishman EK, Jones B, Nussbaum AR, Simmons T. Right lower quadrant pain in the immunocompromised patient: CT findings in 10 cases. AJR Am J Roentgenol 1987; 149(6):1177–1179.
19. Helper DJ. Medical management of Crohn's disease: a guide for radiologists. Eur J Radiol 2009; 69(3):371–374.
20. Horton KM, Corl FM, Fishman EK. CT evaluation of the colon: inflammatory disease. RadioGraphics 2000; 20(2):399–418
21. Hara AK,Swartz PG. CT enterography of Crohn's disease. Abdom Imaging 2009; 34(3):289–295.
22. American College of Radiology. Imaging recommendations for patients with Crohn's disease. ACR Appropriateness Criteria. http://www.acr.org/SecondaryMainMenuCategories/quality_safety/app_criteria/pdf/ExpertPanelonGastrointestinalimaging/CrohnsDiseaseDoc5.aspx. Accessed October 25, 2010.
23. Puylaert JB, Van der Zant FM, Mutsaers JA. Infectious ileocecitis caused by Yersinia, Campylobacter, and Salmonella: clinical, radiological and US findings. Eur Radiol 1997; 7(1):3–9.
24. Leschka S,Alkadhi H,Wildermuth S, Marincek B. Multi-detector computed tomography of acute abdomen. Eur Radiol 2005;15(12):2435–2447
25. Fry RD,Mahmoud N, Maron DJ, Ross HM, Rombeau J. Colon and rectum. In: Townsend CM Jr., ed. Sabiston textbook of surgery: the biological basis of modern surgical practice. 18th ed. Philadelphia, Pa: Saunders, 2007; 1348–1432.
26. Katz DS, Lane MJ, Ross BA, Gold BM,Jeffrey RB Jr., Mindelzun RE. Diverticulitis of the right colon revisited. AJR Am J Roentgenol 1998;171(1):151–156
27. Jang HJ, Lim HK, Lee SJ, Lee WJ, Kim EY, Kim SH. Acute diverticulitis of the cecum and ascending colon: the value of thin-section helical CT findings in excluding colonic carcinoma. AJR Am J Roentgenol 2000; 174(5):1397–1402.28. Chintapalli KN, Chopra S, Ghiatas AA, Esola CC, Fields SF, Dodd GD 3rd. Diverticulitis versus colon cancer: differentiation with helical CT findings. Radiology 1999; 210(2):429–435.
29. Greenstein S, Jones B, Fishman EK, Cameron JL, Siegelman SS. Small-bowel diverticulitis: CT findings. AJR Am J Roentgenol 1986; 147(2):271–274.
30. Krummen DM, Camp LA, Jackson CE. Perforation of terminal ileum diverticulitis: a case report and literature review. Am Surg 1996; 62(11):939–940.
31. Dupre MP, Jadavji I, Matshes E, Urbanski SJ. Diverticular disease of the vermiform appendix: a diagnostic clue to underlying appendiceal neoplasm. Hum Pathol 2008; 39(12):1823–1826.
32. Lee KH, Lee HS, Park SH, et al. Appendiceal diverticulitis: diagnosis and differentiation from usual acute appendicitis using computed tomography. J Comput Assist Tomogr 2007; 31(5):763–769.
33. Hoeffel C, Crema MD, Belkacem A, et al. Multi-detector row CT: spectrum of diseases involving the ileocecal area. RadioGraphics 2006; 26(5):1373–1390.
34. Matsushita M, Hajiro K, Kajiyama T, et al. Malignant lymphoma in the ileocecal region causing intussusception. J Gastroenterol 1994; 29(2):203–207.
35. Macari M, Hines J, Balthazar E, Megibow A. Mesenteric adenitis: CT diagnosis of primary versus secondary causes, incidence, and clinical significance in pediatric and adult patients. AJR Am J Roentgenol 2002; 178(4):853–858.
36. Rao PM, Rhea JT, Novelline RA. CT diagnosis of mesenteric adenitis. Radiology 1997; 202(1):145–149.
37. van Breda Vriesman AC, Lohle PN, Coerkamp EG,Puylaert JB. Infarction of omentum and epiploic appendage: diagnosis, epidemiology and natural history. Eur Radiol 1999; 9(9):1886–1892.
38. Puylaert JB. Right-sided segmental infarction of the omentum: clinical, US, and CT findings. Radiology 1992; 185(1):169–172.
39. Uncu H, Taner D. Appendiceal endometriosis: two case reports. Arch Gynecol Obstet 2008; 278(3):273–275.
40. Sheikh HA, Krishnamurti U,Bhat Y, Rajendiran SA. 42-year-old woman with a 7-month history of abdominal pain. A, endometriosis involving
ileocecal junction and 2 pericolonic lymph nodes; B, intranodal benign glandular inclusions. Arch Pathol Lab Med 2005; 129(12):e218–e221.
41. Horton KM, Fishman EK. MDCT and 3D imaging in transient enteroenteric intussusception: clinical observations and review of the literature. AJR Am J Roentgenol 2008; 191(3):736–742.
42. Tejler G, Jiborn H. Volvulus of the cecum: report of 26 cases and review of the literature. Dis Colon Rectum 1988; 31(6):445–449.
43. Khurana B. The whirl sign. Radiology 2003; 226(1):69–70.
44. Balthazar EJ, Yen BC, Gordon RB. Ischemic colitis: CT evaluation of 54 cases. Radiology 1999; 211(2):381–388.
45. Horton KM, Fishman EK. Multi-detector row CT of mesenteric ischemia: can it be done? RadioGraphics 2001; 21(6):1463–1473.
46. Kiran Jain, Imaging of peritoneal inclusion cysts, American Journal of Roentgenology. 2000;174: 1559-1563.
Downloads
Published
2015-10-31
How to Cite
Goel, D. N., & Shah, D. D. S. (2015). Right Lower Quadrant (RLQ) Pain: Beyond The Boundaries Of Appendicitis: Right Lower Quadrant(RLQ) Pain: Beyond the boundaries of appendicitis. National Journal of Integrated Research in Medicine, 6(5), 125–133. https://doi.org/10.70284/njirm.v6i5.983
Issue
Section
Other
