MANAGEMENT OF LEFT ILIAC FOSSA PAIN IN THE EMERGENCY DEPARTMENT

Authors

  • Mara-Malina BALAN Grigore Popa University of Medicine and Pharmacy Iasi
  • Cristina JARI Grigore Popa University of Medicine and Pharmacy Iasi
  • Irina JARI Grigore Popa University of Medicine and Pharmacy Iasi
  • Corina Veronica LUPASCU-URSULESCU Grigore Popa University of Medicine and Pharmacy Iasi
  • A. G. NAUM Grigore Popa University of Medicine and Pharmacy Iasi
  • Andra-Mara URSU PMP Andra-Mara Ursu, Iași, Romania

DOI:

https://doi.org/10.22551/MSJ.2025.04.08

Abstract

Left iliac fossa (LIF) pain is a common reason for emergency department (ED) visits and can be caused by a wide range of conditions, from benign to life-threatening, timely and accurately diagnosis being crucial for appropriate management. This study aims to highlight the management of LIF pain and to outline the etiology and imaging findings in a real-world ED setting. Materials and methods: We conducted a retrospective study of 144 patients who presented with LIF pain at the ED of Sf. Spiridon County Clinical Emergency Hospital Iași between August 2022 and December 2024. Imaging studies and final diagnoses were analyzed to assess diagnostic pathways and imaging concordance. Results: The patients had a mean age of 53.9 years, with a slight female predominance (56.25%), the most frequent diagnoses being acute diverticulitis (25%). Computed tomography (CT) was performed in 105 cases (72.92%) and provided clarification in nearly a third of the patients who had previously undergone ultrasound (US) and didn’t have a final diagnosis. Overall, CT findings confirmed the ED’s initial diagnostic hypothesis in 75.24% cases. Conclusions: This study offers a detailed analysis of CT utility in a real-world emergency setting, confirming that CT plays an important role in the differential diagnosis of LIF pain in the ED, influencing management decisions and improving clinical outcomes. Our data support the implementation of standardized diagnostic algorithms for LIF pain in the ED, incorporating early CT in selected cases in order to ensure a patient-centered approach.

References

1. Hawkins AT, Wise PE, Chan T, Lee JT, Glyn T, Wood V. Diverticulitis: an update from the age-old paradigm. Current Probl Surg 2020; 57(10): 100862.

2. Manafu EG, Filimon RM, Jari I, et al. Clinical epidemiological study on the incidence of Escherichia coli infections in the cancer patients admitted to Second Surgery Department of the Iasi Regional Institute of Oncology. Med Surg J-Rev Med Chir Soc Med Nat Iasi 2014; 118(3): 796-800.

3. Arce AB, Sixto CGC, Saenz JA, del Pozo JC, et al. Not all acute pain in the left iliac fossa is diverticulitis. European Congress of Radiology 2019, C-0261.

4. Michels G, Horn R, Helfen A, Hagendorff A, Jung C, Hoffmann B, Dietrich CF. Standardized contrast-enhanced ultrasound (CEUS) in clinical acute and emergency medicine and critical care (CEUS Acute): Consensus statement of DGIIN, DIVI, DGINA, DGAI, DGK, ÖGUM, SGUM and DEGUM. Med Klin-Intensivmed 2022; 117(1): 1-23.

5. Wolfe C, Halsey-Nichols M, Ritter K, McCoin N. Abdominal pain in the emergency department: how to select the correct imaging for diagnosis. Open Acc Emerg Med 2022; 14: 335-345.

6. Móré D, Erdmann S, Bischoff A, et al. Comparison of Non-Contrast CT vs. Contrast-Enhanced CT with Both Intravenous and Rectal Contrast Application for Diagnosis of Acute Colonic Diverticulitis: A Multireader, Retrospective Single-Center Study. Diagnostics 2024; 15(1): 29.

7. Gheorghe L, Jari I, Ursaru M, Negru D, Stefanescu C, Naum AG. Neuroendocrine tumors: Choosing the appropriate imaging methods. Med Surg J-Rev Med Chir Soc Med Nat Iasi 2018; 122 (1): 16-22.

8. Tursi A, Scarpignato C, Strate LL, et al; (2020); Colonic diverticular disease. Nat Rev Dis Primers 2020; 6(1): 20.

9. Linzay CD, Pandit S. Acute Diverticulitis, Treasure Island (FL): Stat Pearls Publishing 2023.

10. Plastaras L, Vuitton L, Badet N, et al. Acute colitis: differential diagnosis using multi-detector CT. Clin Radiol 2015; 70(3): 262-269.

11. Acevedo-Castillo CD, Macias-Cruz HM, Ramirez-Cisneros A, et al. Epiploic appendicitis: systematic review of a distinctive pathology. Am Surg 2024; 90(11): 3074-3081.

12. Menon G, Cagir B. Colon Cancer. Treasure Island (FL): Stat Pearls Publishing 2025 PMID: 29262132.

13. Moisii P, Jari I, Ursu AM, Naum AG. The Relationship between Job Strain and Ischemic Heart Disease Mediated by Endothelial Dysfunction Markers and Imaging. Med Lith 2024; 60(7): 1048.

14. Moisii P, Jari I, Moisii L, Ursu AM, Naum AG, Imaging and Biomarkers: The Assessment of Pulmonary Embolism Risk and Early Mortality. Med- Lith 2024; 60(9): 1489.

15. Melissovas I, Cokkinos DD, Antypa EG, Roumbos G. Not only appendicitis! Transabdominal ultrasound detects a variety of pathology in the iliac fossae. Hell J Radiol 2021; 6(3).

16. Bodmer NA, Thakrar KH. Evaluating the patient with left lower quadrant abdominal pain. Radiol Clin 2015; 53(6): 1171-1188.

17. Ursaru M, Jari I, Popescu R, Negru D, Naum AG, Scripcariu V. Multifactorial Analysis of local and lymph node recurrences after conservative or radical surgery for stage 0-II breast cancer. Med Surg J-Rev Med Chir Soc Med Nat Iasi 2014; 118(4): 1062-1067.

18. Moisii P, Jari I, Naum AG, Butcovan D, Tinica G. Takayasu’s Arteritis: A Special Case Report and Review of the Literature. Med Lith 2024; 60(3): 456.

19. Pesapane F, Gnocchi G, Quarrella C, et al. Errors in Radiology: A Standard Review. J Clin Med 2024; 13(15); 4306.

Additional Files

Published

2025-12-19

Issue

Vol. 129 No. 4 (2025): The Medical-Surgical Journal

Section

SURGERY

License

Copyright (c) 2025 The Medical-Surgical Journal

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

COPYRIGHT 
Once an article is accepted for publication, MSJ requests a transfer of copyrights for published articles.

COPYRIGHT TRANSFER FORM FOR 

REVISTA MEDICO-CHIRURGICALĂ A SOCIETĂȚII DE MEDICI ȘI NATURALIȘTI DIN IAȘI /

THE MEDICAL-SURGICAL JOURNAL OF THE SOCIETY OF PHYSICIANS AND NATURALISTS FROM IASI

We, the undersigned authors of the manuscript entitled

_____________________________________________________________________________________

_____________________________________________________________________________________

warrant that this manuscript, which is submitted for publication in the REVISTA MEDICO-CHIRURGICALĂ, has not been published and it is not under consideration for publication in another journal.

  1. we give the consent for publication in the REVISTA MEDICO-CHIRURGICALĂ, in printed and electronic format and we transfer unconditioned and complete the copyright of this manuscript to the REVISTA MEDICO-CHIRURGICALĂ, in the event of its acceptance.
  2. the manuscript does not break the intellectual property rights of any other person.
  3. we have read the submitted version of the manuscript and we are fully responsible for the content.

Names and signatures of authors / copyright owners (the following sequence is the authorship of the article):

  1. ______________________________/_________________________
  2. ______________________________/_________________________
  3. ______________________________/_________________________

N.B.  All the authors must sign this form