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Updated: Jun 19, 2026

Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
A case of malignant abdominal pain
Raghuwansh P Sah1, Rajeswari Anaparthy, Aravind Sugumar
1Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Background:
Testicular cancer is a common neoplasm in young and middle-aged men. Although the most common presentation is a palpable testicular mass, it can present with atypical symptoms. There is a lack of awareness among primary-care physicians about the less common presentations of testicular tumors. Early detection is a key prognostic variable. This case demonstrates an unusual first presentation of testicular cancer with chylous ascites and abdominal pain.
Case Report:
We report a case of a 19-year-old man who presented with severe atypical abdominal pain, which was initially diagnosed as acute appendicitis. He underwent laparoscopic appendectomy and was found to have chylous ascites and a normal-appearing appendix. As part of his work-up for chylous ascites, he was found to have mesenteric lymphadenopathy. These nodes were sampled and revealed a mixed germ cell tumor. The primary tumor was later traced to his right testis.
Conclusions:
The differential diagnosis of atypical abdominal pain in young men should include testicular tumors. A thorough testicular exam should be part of the routine physical exam in such situations.
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