Differential Diagnosis for Lower Abdominal Pain
The patient's symptoms of sudden sharp pain in the lower abdomen, worsening with movement and walking, and a feeling of pulling, suggest several possible diagnoses. Here's a categorized list of potential causes:
- Single most likely diagnosis
- Muscle strain: The patient's history of pulling trays from a rack and feeling a sudden sharp pain is consistent with a muscle strain, likely involving the abdominal or lower back muscles. The pain worsening with movement and walking also supports this diagnosis.
- Other Likely diagnoses
- Hernia: The patient's symptoms, such as a sudden sharp pain and a feeling of pulling, could be indicative of a hernia, particularly an inguinal hernia.
- Kidney stone: Although less likely, a kidney stone could cause severe pain in the lower abdomen, which may worsen with movement.
- Ovarian torsion is unlikely in a male, but testicular torsion: Testicular torsion is a possible diagnosis in a male patient, especially if the pain is localized to one side and is accompanied by nausea and vomiting.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Appendicitis: Although the patient's symptoms do not typically suggest appendicitis, it is a critical diagnosis that should not be missed, as a delayed diagnosis can lead to severe complications.
- Ectopic pregnancy is unlikely in a male, but a ruptured abdominal aortic aneurysm: A ruptured abdominal aortic aneurysm is a life-threatening condition that requires immediate attention. Although rare in a 21-year-old male, it should be considered in the differential diagnosis.
- Intestinal obstruction: An intestinal obstruction can cause severe abdominal pain, nausea, and vomiting. If left untreated, it can lead to serious complications, including bowel ischemia and perforation.
- Rare diagnoses
- Testicular cancer: Testicular cancer can cause a dull ache or sharp pain in the testicle, but it is a rare diagnosis and would not typically present with sudden onset of pain after physical activity.
- Inguinal ligament avulsion: An inguinal ligament avulsion is a rare injury that can occur during heavy lifting or bending, causing severe pain in the groin area.