Mittelschmerz
Background
- Lower abdominal or pelvic pain during ovulation
- From German for "middle pain."
Clinical Features
- Pain occurs roughly halfway of menstrual cycle
- Should not have any additional symptoms
- Abdominal/pelvic exam benign
Differential Diagnosis
RLQ Pain
- Appendicitis
- Perforated appendicitis
- Peritonitis
- Abdominal aortic aneurysm
- Crohn's disease (terminal ileitis)
- Diverticulitis (cecal, Asian patients)
- Ectopic
- Endometriosis
- Epiploic appendagitis
- Herpes zoster
- Inguinal hernia
- Ischemic colitis
- Kidney stone
- Meckel's diverticulum
- Mesenteric lymphadenitis
- Mesenteric ischemia
- Mittelschmerz
- Neutropenic enterocolitis (typhlitis)
- Ovarian cyst
- Ovarian torsion
- PID
- Pyelonephritis
- Psoas abscess
- Testicular torsion
LLQ Pain
- Diverticulitis
- Kidney stone
- UTI
- Pyelonephritis
- Ectopic pregnancy
- Infectious colitis
- Inflammatory bowel disease (Crohn's Disease, Ulcerative Colitis)
- Inguinal hernia
- Mesenteric ischemia
- Epiploic appendagitis
- Mittelschmerz
- Ovarian cyst
- Ovarian torsion
- PID
- Psoas abscess
- Testicular torsion
- Appendicitis
- Abdominal aortic aneurysm
- Herpes zoster
- Endometriosis
- Colon cancer
- Irritable bowel syndrome
- Small bowel obstruction
Evaluation
- Frequently a diagnosis of exclusion
Management
- Benign, analgesia as needed
Disposition
- Outpatient