Differential Diagnosis
- Single most likely diagnosis
- Diverticulitis: The patient's symptoms of severe lower abdominal cramping, worsening over 3 days, and tenderness below the belly button are consistent with diverticulitis, especially given the patient's age and smoking history. The ability to pass gas and having a small bowel movement suggests that the bowel is not completely obstructed.
- Other Likely diagnoses
- Constipation: Although the patient reports severe cramping and limited bowel movements, constipation could be a contributing factor, especially given the patient's weight and potential for decreased mobility.
- Bowel obstruction: The patient's symptoms of abdominal cramping, limited bowel movements, and ability to pass gas could also be indicative of a bowel obstruction, which could be partial or complete.
- Inflammatory bowel disease (IBD): The patient's symptoms of abdominal cramping and limited bowel movements could be consistent with IBD, such as Crohn's disease or ulcerative colitis, although the acute onset and severity of symptoms might be less typical.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Appendicitis: Although the patient's symptoms are more consistent with diverticulitis, appendicitis is a potentially life-threatening condition that must be considered, especially if the patient's pain is localized to the right lower quadrant.
- Mesenteric ischemia: This condition, which involves decreased blood flow to the intestines, can present with severe abdominal pain and could be life-threatening if not promptly diagnosed and treated.
- Sigmoid volvulus: This condition, which involves twisting of the sigmoid colon, can cause severe abdominal pain and obstruction, and requires prompt diagnosis and treatment to prevent complications.
- Rare diagnoses
- Intussusception: This condition, which involves telescoping of one portion of the intestine into another, can cause abdominal pain and obstruction, but is relatively rare in adults.
- Colonic carcinoma: Although less likely given the acute onset of symptoms, colonic carcinoma could potentially cause abdominal pain and obstruction, and should be considered in the differential diagnosis, especially given the patient's age and smoking history.