Differential Diagnosis for Left Sided Abdominal Pain Radiating to the Back

Single Most Likely Diagnosis

• Nephrolithiasis (Kidney Stones): This condition often presents with severe, colicky pain that radiates from the flank to the groin, but can also radiate to the back. The pain is typically unilateral and can be accompanied by nausea, vomiting, and hematuria.

Other Likely Diagnoses

• Pyelonephritis: An infection of the kidney that can cause flank pain radiating to the back, along with symptoms like fever, chills, and dysuria.
• Pancreatitis: Inflammation of the pancreas that can cause severe abdominal pain radiating to the back, often accompanied by nausea, vomiting, and elevated pancreatic enzymes.
• Diverticulitis: Inflammation of a diverticulum in the colon, which can cause left lower quadrant abdominal pain radiating to the back, along with changes in bowel habits and possible fever.
• Gastrointestinal issues like constipation or bowel obstruction: These can cause abdominal pain that may radiate to the back, especially if the obstruction is partial and involves the left colon.

Do Not Miss Diagnoses

• Aortic Dissection: A life-threatening condition where the inner layer of the aorta tears, causing severe, tearing chest pain that can radiate to the back. Although it typically presents with chest pain, abdominal pain can occur if the dissection involves the abdominal aorta.
• Ectopic Pregnancy: A pregnancy that develops outside the uterus, often causing severe abdominal pain that can radiate to the back, along with vaginal bleeding and missed periods. This is a medical emergency.
• Ruptured Abdominal Aortic Aneurysm (AAA): A life-threatening condition where an aneurysm in the abdominal aorta ruptures, causing severe abdominal and back pain, often accompanied by hypotension and shock.

Rare Diagnoses

• Splenic Infarction or Rupture: Although more commonly associated with trauma, a spontaneous rupture or infarction of the spleen can cause severe left upper quadrant abdominal pain radiating to the back.
• Left Ovarian Torsion: A condition where the ovary twists around its ligaments, cutting off its blood supply, and can cause severe, sudden onset abdominal pain that may radiate to the back.
• Pheochromocytoma: A rare tumor of the adrenal gland that can cause episodic hypertension, sweating, palpitations, and abdominal or back pain due to catecholamine release.