Differential Diagnosis for Severe Lower Abdominal Pain and Scrotal Symptoms in a 14-Year-Old Boy
- Single Most Likely Diagnosis
- Testicular Torsion: This condition is highly suspected due to the acute onset of severe pain, nausea, vomiting, and the specific findings on physical examination, including severe tenderness on palpation of the scrotum that persists with elevation of the testes (Prehn's sign is typically negative in testicular torsion, as elevation does not relieve pain) and the absence of the cremasteric reflex (elevation of the scrotum in response to stroking the inner thigh). Testicular torsion is a medical emergency requiring prompt intervention.
- Other Likely Diagnoses
- Epididymitis: Although less likely given the absence of urinary symptoms and the negative Prehn's sign, epididymitis could still be considered, especially if there's a history of urinary tract infections or sexually transmitted infections. However, the acute onset and specific physical findings point more towards testicular torsion.
- Strangulated Hernia: While a hernia could cause severe pain and nausea, the specific location and nature of the pain, along with the scrotal findings, make this less likely. A hernia would typically present with a palpable mass and more pronounced abdominal findings.
- Do Not Miss Diagnoses
- Appendicitis: Although the primary symptoms and signs point towards a scrotal or testicular issue, appendicitis can sometimes present with atypical symptoms, including lower abdominal or pelvic pain that might radiate to the groin. Missing appendicitis could lead to severe complications, including perforation and peritonitis.
- Testicular Tumor: While less likely to cause acute severe pain, testicular tumors can present with a range of symptoms, including pain. However, they are typically more insidious in onset and might not cause the acute, severe symptoms described.
- Rare Diagnoses
- Varicocele: This condition involves dilation of the veins within the scrotum and is more commonly associated with a gradual onset of symptoms, including a feeling of heaviness or aching in the scrotum. It's less likely given the acute presentation.
- Hydrocele: A hydrocele is an accumulation of fluid in the scrotum and can cause swelling. While it might cause some discomfort, it's unlikely to cause the severe, acute pain described in this scenario.
- Henoch-Schönlein Purpura (HSP): This is a form of vasculitis that can cause abdominal pain, joint pain, and sometimes scrotal swelling and pain. However, it's typically associated with a rash and other systemic symptoms, making it less likely in this case.