Diverticulitis

Renal colic mimics

EMKF

 

  • Some mimics of renal colic that may arrive at the ED include: upper UTI’s, ectopic pregnancies, ovarian torsion, adnexal masses, testicular torsion, acute aortic syndromes, renal artery aneurysms, renal infarction, splenic infarction, bowel obstruction, diverticulitis, appendicitis, biliary colic, cholecystitis, acute intestinal ischemia, pneumonia, pulmonary embolism, retroperitoneal hematoma, iliopsoas abscess.
  • Focused history and physical exam are paramount due to the multitude of structures in the area and potentially dangerous conditions that may mimic renal colic.
  • Flank pain and hematuria are the hallmarks of renal colic, however, the presentation is variable.
  • Diagnosis can be confirmed with CT scan, which will show most other potential items in the differential if the scan is negative for a stone.

 

Why on earth does radiology insist on oral contrast?

EMKF

Small Bowel Obstruction – Oral contrast is contraindicated in suspected in SBO. IV contrast is preferred, but not required.

Suspected appendicitis – Oral contrast is not required, but may be beneficial in extremely thin individuals (e.g. BMI < 18), or non-obese children.

Suspected diverticulitis – Oral contrast is not required

Unclear etiology – PO contrast is suggested by some experts in undifferentiated abd pain if the patient is very thin (e.g. < 120 pounds, BMI < 18); has had a Roux-en-Y gastric bypass; or has and inflammatory bowel disease that could produce a fistula