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
- 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
- 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
A gray-scale sonogram shows a dominant follicle with a much smaller, cystic-appearing structure at the periphery of the follicle, the cumulus oophorus (arrow). This is indicative of imminent ovulation.
- Frequently a diagnosis of exclusion
Management
- Benign, analgesia as needed
Disposition
- Outpatient
See Also
External Links
References
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