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Introduction: A myriad of pathologies can cause abdominal pain. Genitourinary causes including testicular torsion must be considered. Case Report: In this report, we present a 17-year-old male evaluated in the emergency department for lower abdominal pain. After physical exam, computed tomography, and ultrasound were completed, torsion of undescended testicle within the inguinal canal was diagnosed. Surgical exploration revealed a twisted, ischemic testis, and subsequent orchiectomy was performed. Conclusion: This case highlights the importance of a thorough genitourinary exam in patients with lower abdominal pain.