Based on research, it was found that almost 88% of outpatient consults were due to abdominal pain and other gut-associated symptoms . Abdominal pain, however, is a very broad area of clinical manifestation.
Because the abdomen is comprised of numerous organs, a method dividing the abdomen into four quadrants was devised. This is very helpful, most especially in performing physical examination and evaluating symptoms localized in the abdomen.
Using a median sagittal and a transverse plane passing the umbilicus at right angles, the abdomen is divided into the quadrants: right upper, right lower, left upper and left lower. It is only the left quadrants, however, that this article will focus on. 
This image shows the abdomen divided into quadrants: right upper, right lower, left upper and left lower.
What’s “Left” in the Abdomen
In assessing left abdominal pain, it is of utmost importance that one knows what organs lie within that particular section. Problems in the organs at this side of the abdomen may cause left sided abdominal pain. These particular “left” organs include :
- Body and tail end of pancreas
- Left half of transverse colon and large intestine
- Descending colon
- Sigmoid colon
- Left adrenal gland
- Left kidney
- Left ureter
- Left fallopian tube
- Left part of uterus
- Left ovary/testis
However, in rare cases, pathologies of the abdominal organs on the right side, can also cause referred pain on the left side of the abdomen, and is still worth considering.
An image showing the abdominal quadrants and the different organs lying within.
Left Sided Abdominal Pain: The Usual Suspects
There are numerous conditions presented as left sided abdominal pain. The more common reasons of which include the following: [4, 5, 6, 7]
Usually due to either infection or stress, this presents as stomach pain, vomiting, nausea and bloatedness. It is due to an inflamed gastric lining.
2. Irritable Bowel Syndrome
With manifestations such as abdominal pain, alternating bouts of diarrhea and constipation, and bloatedness, this disorder is characterized by abnormality of the bowel functions.
Presenting as left sided abdominal pain, this refers either to passage of hard stools or inability to regularly pass the stools. This is usually caused by consumption of a diet low in fiber, dehydration and stress.
Usual in patients of old age, this presents as left lower abdominal pain. It is brought about by inflammation of the diverticulum, a small pouch found along the intestines.
5. Crohn’s Disease
With left sided abdominal pain as its main symptom, crohn’s disease is an inflammation of the intestine, specifically the ileum. It has a cobblestone appearance upon endoscopy.
6. Ulcerative Colitis
Like Crohn’s Disease, this is another type of inflammatory bowel disease. It is presented with ulcer formation in the intestinal lining, particularly in the rectum and colon. Aside from abdominal pain on the left side, it is also manifested by diarrhea and rectal bleeding.
7. Renal Stones
Attributable to dehydration and high levels of uric acid and calcium, patients with kidney lithiasis can experience left sided abdominal pain. This is usually associated with nausea, vomiting, fever and groin pain.
8. Ovarian Cyst
Pain in the left side of the abdomen among women may pertain to an ovarian pathology. This is usually secondary to a fluid filled cyst present in the ovary.
9. Abdominal Aneurysm
Characterized as a sudden, severe abdominal pain, this may be brought about by a ruptured aneurysm of the abdominal aorta. Aside from the gut pain, the patient may also experience pallor and may sudden lose consciousness.
10. Bowel Obstruction
Left sided abdominal pain may come from bowel obstruction also of the organs on the left side of the abdomen. This may be associated with nausea and abdominal distention. If complete obstruction is considered, one must also note for fecal impaction and inability to release gas (flatus).
11. Colon Cancer
Aside from abdominal pain localized on the left quadrants, there may also be a change in the bowel movement for more than 4 days, blood tinged stools, unexplained weight loss, anorexia, and easy fatiguability.
This left sided abdominal pain is caused by the abnormal presence of uterine tissue at the external part of the womb.
Diagnostics for Left Sided Abdominal Pain [4, 5]
A complete and thorough history and physical examination will help in achieving a correct diagnosis. Examination of the spleen, including its size, should be made to rule out splenomegaly. Pelvic or rectal examination, on the other hand, may also be required to further localize pain on the left upper quadrant.
Blood examinations should include liver and renal function tests, serum calcium, capillary blood glucose test and serum beta hCG. Aside from urine analysis, urine culture and dipstick test is a must. If the patient is a woman and of childbearing age, it is recommended that a pregnancy test be done.
Radiographic tests to be performed are plain abdominal xrays (both upright and supine), a kidney-ureter-bladder film, and chest xrays. Ultrasonograms of the pelvis and abdomen may also be utilized, as well as both MRI and CT scans. To further rule out cardiac pathology, an electrocardiogram should be done. If still clueless despite the said diagnostics, an endoscopy, or even a diagnostic laparoscopy, may be carried out.
Managing Left Sided Abdominal Pain
Pain in the left side of the abdomen, or in any other side of the abdomen for that matter, should not be treated symptomatically, but should be cut in its roots. The cause should be immediately identified and addressed to. Thus, consultation with a physician is invaluable. [ 4, 5]
1. Bosch, X. et al. Outpatient Quick Diagnosis Units for the Evaluation of Suspected Severe Diseases: An Observational, Descriptive Study. Clinics. 2011; 66(5).
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