Left lower quadrant (LLQ) abdominal pain is a common presentation in the adult population. The identification and prompt referral of relevant surgical conditions can be key to reducing surgical morbidity and is a cornerstone of high-quality healthcare. Common surgical conditions include diverticulitis, left ureteric stone(s), and left adnexal pathology in the female population. Overlapping left groin or left flank pain should be considered. CT scan of the abdomen and pelvis with intravenous contrast is the investigation of choice that will quickly direct the referral to the relevant surgical service. However, guided by appropriate history, examination, and laboratory results, an abdominal and/or pelvic ultrasound may be the appropriate first-line investigation.