A 55-year-old man is admitted to the hospital with nausea, vomiting, and hematuria. A CT scan examination reveals a neoplasm in the posterior surface of the inferior pole of the left kidney that has invaded through the renal pelvis, renal capsule, ureter, and fat. To which of the following regions will pain most likely be referred?
Visceral pain from the kidneys and the ureter at the point of the neoplasm is mediated via T11 and T12 spinal cord levels. Therefore, pain is referred to these dermatomes leading to pain in the upper gluteal, pubic, medial thigh, scrotal, and labial areas (from subcostal and iliohypogastric nerves, in particular). In contrast, the umbilical region, the T10 dermatome, is supplied by the T10 spinal nerve, excluding it from being the correct answer. The dermatomes that supply the anterior and lateral thighs are of upper lumbar origin and would not receive pain referred from the kidneys.
Skin of the anterior and lateral thighs and femoral triangle
Skin over the gluteal region, pubis, medial thigh, and scrotal areas
Skin over the medial, anterior, and lateral side of the thigh
Skin over the pubis and umbilicus
Abdomen & Pelvis