Page 125 - Registrar Orientation Manual 2016

Reference:
1257
Effective date:
7 July 2015
Expiry date:
6 July 2018
Page:
8 of 35
Title:
Imaging Guidelines
Type:
Clinical Guideline
Version:
02
Authorising initials:
Left Iliac Fossa Pain
Causes of acute left iliac fossa pain to consider include:
• acute sigmoid diverticulitis
• tubo-ovarian pathology and ectopic pregnancy in females
• ischaemic colitis
• pseudomembranous colitis
• inflammatory bowel disease
• locally perforated sigmoid carcinoma
• renal colic
• leaking abdominal aortic aneurysm
An erect CXR is useful in excluding pneumo-peritoneum and in the assessment of coincidental cardiorespiratory pathology. An abdominal X-ray rarely helps.
In young female patients, US should be performed initially to detect gynaecological causes.
In suspected acute colonic diverticulitis, if investigation is needed, CT is the usual first line test.
Indications for CT include:
• when patient is seriously ill
• when clinical diagnosis is in doubt
• clinical deterioration
• exclusion of pericolic abscess
Response
Acute Left Iliac Fossa Pain
Is patient a female of reproductive age?
Pelvic +/- Transvaginal USS
No
Yes
Suspected Renal Colic
CT
May be indicated in some cases:
• when patient is seriously ill
• clinical diagnosis is in doubt
• clinical deterioration
• to exclude peri-colic abscess
Majority of other clinical scenarios
Click here
CT
Acute Diverticulitis and no abscess
Acute Diverticulitis with abscess
Other cause found or CT normal
Conservative Treatment
Percutaneous drainage or surgery
Treat or further investigate as necessary
Deterioration
Repeat CT
No further imaging or investigation is usually required