Differential Diagnosis for Lower Right Abdominal Pain Radiating to the Back

The patient's symptoms of lower right abdominal pain radiating to the back up towards the ribs suggest several possible diagnoses. These can be categorized based on their likelihood and potential impact on the patient's health.

• Single Most Likely Diagnosis
  • Appendicitis: This condition is a common cause of lower right abdominal pain, which can sometimes radiate to the back. The pain often starts near the belly button and then moves to the lower right abdomen. Appendicitis requires prompt medical attention.
• Other Likely Diagnoses
  • Kidney stones (nephrolithiasis): Stones in the right kidney can cause severe pain that starts in the abdomen and radiates to the back, often up towards the ribs. The pain can be intermittent and may be accompanied by nausea, vomiting, and blood in the urine.
  • Pyelonephritis: An infection of the right kidney can cause pain in the lower back and abdomen, fever, and other symptoms like frequent urination and dysuria.
  • Diverticulitis: Inflammation of a diverticulum in the right colon can cause lower right abdominal pain, which may radiate to the back. It's often accompanied by changes in bowel habits and fever.
• Do Not Miss Diagnoses
  • Ectopic pregnancy: Although less common, an ectopic pregnancy can present with lower abdominal pain that radiates to the back and is a medical emergency. It's crucial to consider this diagnosis, especially in women of childbearing age.
  • Ruptured abdominal aortic aneurysm: This is a life-threatening condition that can cause sudden, severe abdominal and back pain. It's more common in older adults, especially those with a history of smoking or hypertension.
  • Pancreatitis: Inflammation of the pancreas can cause severe abdominal pain that radiates to the back. It's often associated with nausea, vomiting, and elevated pancreatic enzymes.
• Rare Diagnoses
  • Right-sided ovarian torsion: This condition involves the twisting of the ovary, which can cause severe, sudden pain in the lower abdomen that may radiate to the back. It's more common in women with ovarian cysts.
  • Intestinal obstruction: A blockage in the intestines can cause severe abdominal pain, which may radiate to the back, along with nausea, vomiting, and constipation.
  • Psoas abscess: An abscess in the psoas muscle can cause lower abdominal and back pain, often accompanied by fever and limited mobility of the hip.

Each of these diagnoses has distinct characteristics and requires a thorough medical evaluation to determine the cause of the patient's symptoms.