Mid lower abdominal pain with low back pain not of musculoskeletal origin — which diagnosis is most likely?

• A. Enlarged liver
• B. Inflamed pancreas
• C. Ruptured gallbladder
• D. Dissecting aortic aneurysm

Answer: (D)

When pain in the mid-lower abdomen is paired with low back pain and there’s no obvious musculoskeletal origin, think about a vascular emergency rather than an organ-related problem. A dissecting aortic aneurysm can involve the abdominal aorta, producing abdominal pain that can be felt in the mid region and radiate to the back. This condition is life-threatening and requires urgent imaging and vascular specialist involvement.

In contrast, enlarged liver would usually cause more diffuse or localized tenderness and signs of liver disease; pancreatitis pain is typically epigastric and radiates to the back but is often linked to risk factors and abnormal lab findings; gallbladder issues usually present with right upper quadrant pain, nausea, or fever. The combination of mid-lower abdominal and back pain without a musculoskeletal source makes a dissecting aortic aneurysm the most likely diagnosis.