Clinical Indicators for Differential Diagnosis of Acute Lower Abdominal Pain in Women of Reproductive Age

Kijja Jearwattanakanok, Sirikan Yamada, Watcharin Suntornlimsiri, Waratsuda Smuthtai, Jayanton Patumanond


Background: Acute lower abdominal pain in women of reproductive age is a challenging condition for clinical diagnosis. Computerized tomography yields high accuracy, but may not be cost-effective in low-middle income countries. Selective diagnostic approach based on clinical findings may be more appropriate.

Methods: Medical record review was performed on patients aging between 15 - 50 years who admitted to the surgical department or obstetrics and gynecology (OB-GYN) unit because of acute lower abdominal pain during January to December 2008. Patients were eventually categorized into appendicitis, OB-GYN conditions, or non-specific abdominal pain (NSAP). Clinical indicators were studied for diagnostic values using polytomous logistic regression applied to likelihood ratio for positive test (LR+) and confidence interval (CI).

Results: Anorexia, nausea and vomiting, shifting of abdominal pain decreased the likelihood of OB-GYN conditions. Diarrhea increased the likelihood of NSAP. Right lower quadrant tenderness increased the likelihood of appendicitis but decreased the likelihood of OB-GYN conditions. Left lower quadrant tenderness decreased the likelihood of appendicitis but increased the likelihood of OB-GYN. Guarding or rebound tenderness increased the likelihood of appendicitis but reduced the likelihood of NSAP. Leucocytosis (white blood cell count >= 10,000) increased the likelihood of appendicitis but reduced the likelihood of OB-GYN and NSAP. Neutrophil >= 75% increased the likelihood of OB-GYN but decreased the likelihood of NSAP. Pregnancy reduced the likelihood of appendicitis and increased the likelihood of OB-GYN.

Conclusion: Gastrointestinal symptoms, sites of abdominal tenderness, guarding or rebound tenderness, leucocytosis, neutrophil >= 75% and pregnancy are clinical indicators that may help differentiating appendicitis, common OB-GYN conditions, or NSAP in acute lower abdominal pain in women of reproductive age.



Lower abdominal pain; Pelvic pain; Appendicitis; Ectopic pregnancy; Ovarian cyst; Non-specific abdominal pain; Likelihood ratio; Polytomous logistic regression

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