A previously healthy male presenting to an emergency department with acute flank, abdominal, and testicular pain can be manifestation of multiple potential causes. The correct approach to such a patient is based primarily on the history and physical exam to narrow down the diagnostic possibilities and guide further testing, if any is needed. The combination of testicular pain and abdominal/flank pain can represent testicular or abdominal/flank pathology. A careful abdominal and genitourinary exam is, therefore, mandatory. The exam should include auscultation, inspection, and four quadrant palpation of the abdomen as well as inspection and palpation of the genitalia, including the testicles.
Work-up of acute flank, abdominal, and testicular pain medical expert witness specialties include urology, emergency medicine, pediatric emergency medicine, and pediatric urology.