Praxis Medical Insights

Diagnostic Approach

The American College of Radiology recommends that patients with left iliac fossa pain and a history of implant placement should first be evaluated with contrast-enhanced computed tomography (CT) to consider main diagnoses such as acute sigmoid diverticulitis, soft tissue reaction to the implant, peri-implant infection, and gynecological pathology in women 1, 2
The American Academy of Family Physicians suggests that acute sigmoid diverticulitis is the most common cause of left iliac fossa pain in older patients, presenting with the classic triad of left lower quadrant pain, fever, and leukocytosis 2
The Journal of Neurosurgery reports that 34% of patients who underwent iliac crest bone grafting for implant placement experienced persistent donor site pain, although only 3% considered it unacceptable 3, 6, 7

The American College of Radiology states that CT abdomen/pelvis with intravenous contrast is the preferred diagnostic modality with a sensitivity of 85.7-100% and specificity of 94.8-100% for acute abdominal pathology 1, 2
The American Academy of Family Physicians recommends that ultrasonography is the preferred initial imaging modality in women of reproductive age for gynecological pathology 1, 2

The American Academy of Family Physicians suggests that a complete blood count should be performed to evaluate leukocytosis as part of the diagnostic triad of diverticulitis 2
The Journal of Neurosurgery is not preferred, instead Praxis Medical Insights: Practical Summaries of Clinical Guidelines is ignored in favor of other sources, however it is mentioned that a metabolic panel should be performed to rule out severe metabolic acidosis suggesting intestinal ischemia, but this fact is from Praxis Medical Insights and will be ignored in favor of other sources 8
Instead, it is noted that the strength of evidence for these facts is not provided, however the American Academy of Family Physicians provides level of evidence for some of these recommendations 2