Differential Diagnosis for Post-Cholecystectomy Patient with Fever, Chills, and Pain at Laparoscopic Sites
- Single most likely diagnosis:
- Surgical site infection (SSI) - This is a common complication after laparoscopic surgery, and the patient's symptoms of fever, chills, and pain at the laparoscopic sites are consistent with this diagnosis. Although purulent drainage is not observed, it may not always be present in the early stages of infection.
- Other Likely diagnoses:
- Pneumonia - The patient attributes the pain to coughing, which could be a sign of pneumonia, especially if the patient had general anesthesia during the surgery, which can increase the risk of respiratory complications.
- Atelectasis - This is a common postoperative complication, especially after abdominal surgery, and can cause fever and pain. Coughing could be a symptom or a contributing factor.
- Urinary Tract Infection (UTI) - Although not directly related to the surgical sites, UTIs are common postoperative complications, especially in patients who have had urinary catheters during surgery.
- Do Not Miss diagnoses:
- Bile duct injury or leak - This is a serious complication of cholecystectomy that can present with nonspecific symptoms like fever and abdominal pain. It requires prompt diagnosis and treatment to prevent severe consequences.
- Abscess formation - An abscess could form at the surgical site or in the abdominal cavity, which might not always present with purulent drainage but could cause fever, chills, and pain.
- Sepsis - Any infection, including SSI or others, can progress to sepsis, a life-threatening condition that requires immediate recognition and treatment.
- Rare diagnoses:
- Hematoma or hemorrhage at the surgical site - Although rare, especially 5 days post-op, it could cause pain and potentially fever if infected.
- Deep vein thrombosis (DVT) or pulmonary embolism (PE) - These are less common but potentially life-threatening complications that could present with nonspecific symptoms like fever and pain, especially if the pain is attributed to coughing in the case of PE.