Differential Diagnosis
- Single most likely diagnosis
- Diverticulitis: The patient's symptoms of severe lower abdominal cramping, worsening over time, 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: The patient's symptoms of abdominal cramping, difficulty having a bowel movement, and passing gas could be indicative of severe constipation, which is common in older adults and can be exacerbated by a lack of physical activity and a diet low in fiber.
- Bowel Obstruction: Although the patient can pass gas, a partial bowel obstruction could still be present, causing severe abdominal cramping and difficulty having a bowel movement.
- Irritable Bowel Syndrome (IBS): The patient's symptoms of abdominal cramping and changes in bowel habits could be consistent with IBS, although the severity and progression of symptoms over a short period are less typical for IBS.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Appendicitis: Although the patient's symptoms are not classic for appendicitis (e.g., the pain is not localized to the right lower quadrant), it is a diagnosis that cannot be missed due to the risk of perforation and peritonitis.
- Mesenteric Ischemia: This is a rare but life-threatening condition that can present with severe abdominal pain, and the patient's smoking history increases the risk of vascular disease.
- Ovarian Torsion (less likely in males, but can occur in rare cases): Although extremely rare in males, ovarian torsion can present with severe abdominal pain and should be considered in the differential diagnosis to avoid missing this potentially life-threatening condition.
- Rare diagnoses
- Intussusception: A rare condition in adults, intussusception occurs when a part of the intestine telescopes into another part, causing bowel obstruction and severe abdominal pain.
- Volvulus: A twisting of the intestine that can cause bowel obstruction and severe abdominal pain, volvulus is a rare condition that requires prompt diagnosis and treatment to prevent complications.