What is the cause of severe lower abdominal cramping in a 61-year-old male smoker with constipation and tenderness below the umbilicus?

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Last updated: February 7, 2025 • View editorial policy

Differential Diagnosis

  • Single most likely diagnosis + Diverticulitis: The patient's symptoms of severe lower abdominal cramping, particularly the pain being worse below the belly button, and the absence of nausea, vomiting, and fever, are consistent with diverticulitis. The patient's age, smoking history, and obesity also increase the risk for this condition.
  • Other Likely diagnoses + Constipation: Given the patient's small bowel movement in 3 days and ability to pass gas, constipation is a possible cause of the abdominal cramping. The patient's obesity and lack of physical activity (inferred from smoking and high BMI) may contribute to constipation. + Irritable Bowel Syndrome (IBS): The patient's abdominal cramping and altered bowel habits could be consistent with IBS, although the severity of the pain and the acute onset are less typical for IBS. + Intestinal Obstruction: Although the patient can pass gas, a partial obstruction could still cause severe abdominal cramping and altered bowel habits. The patient's age and smoking history increase the risk for intestinal obstruction.
  • Do Not Miss (ddxs that may not be likely, but would be deadly if missed.) + Appendicitis: Although the pain is typically more localized to the right lower quadrant, appendicitis can present with pain in the lower abdomen and should be considered, especially if the patient's pain shifts or worsens. + Mesenteric Ischemia: This is a life-threatening condition that can cause severe abdominal pain, and the patient's smoking history and obesity increase the risk. The absence of nausea, vomiting, and fever does not rule out this diagnosis. + Ovarian Torsion (less likely in males, but can occur in rare cases): Although extremely rare in males, ovarian torsion can cause severe lower abdominal pain and should be considered in the differential diagnosis.
  • Rare diagnoses + Inflammatory Bowel Disease (IBD): The patient's symptoms could be consistent with a flare of IBD, such as Crohn's disease or ulcerative colitis, although the acute onset and lack of other symptoms (e.g., diarrhea, weight loss) make this less likely. + Colonic Volvulus: This is a rare condition where the colon twists, causing severe abdominal pain and altered bowel habits. The patient's ability to pass gas makes this less likely, but it should still be considered in the differential diagnosis.

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