Differential Diagnosis for Abdominal Pain Extending to Testicle and Groin

Single Most Likely Diagnosis

• Appendicitis: The pain often starts near the belly button and then moves to the lower right abdomen, but in some cases, it can radiate to the groin and testicle, especially if the appendix is located near the psoas muscle or has ruptured, causing irritation of nearby structures.

Other Likely Diagnoses

• Kidney Stones (Nephrolithiasis): Pain from kidney stones can start in the flank or abdomen and radiate to the groin and testicle due to the shared nerve supply. The pain is often severe and can be accompanied by nausea, vomiting, and urinary symptoms.
• Inguinal Hernia: An inguinal hernia can cause pain in the groin that may radiate to the testicle and, in some cases, be referred to the abdomen, especially if the hernia is large or incarcerated.
• Epididymitis: Inflammation of the epididymis can cause severe testicular pain that may radiate to the groin and lower abdomen, often accompanied by urinary symptoms and fever.

Do Not Miss Diagnoses

• Testicular Torsion: A medical emergency where the spermatic cord becomes twisted, cutting off the blood supply to the testicle. It presents with sudden, severe testicular pain that may radiate to the groin and abdomen, and requires immediate surgical intervention to save the testicle.
• Ruptured Aortic Aneurysm: Although less common, a ruptured abdominal aortic aneurysm can cause severe abdominal pain that radiates to the groin and testicle due to the proximity of the aorta to the psoas muscle and the potential for retroperitoneal bleeding to irritate nearby structures.
• Ovarian Torsion (in females): Similar to testicular torsion, ovarian torsion is a gynecologic emergency that can cause severe lower abdominal pain radiating to the groin, necessitating prompt surgical intervention.

Rare Diagnoses

• Psoas Abscess: An abscess in the psoas muscle can cause abdominal pain that radiates to the groin and testicle due to the muscle's location and its potential to irritate nearby nerves and structures.
• Spermatic Cord Torsion: A rare condition where the spermatic cord (excluding the testicle) becomes twisted, leading to pain that may mimic testicular torsion but without the testicular involvement.
• Retroperitoneal Hemorrhage: Bleeding into the retroperitoneal space can cause abdominal pain that radiates to the groin and testicle, often due to trauma, anticoagulation, or vascular diseases.