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. However, the severity of the pain and its localization suggest that there might be a more serious underlying condition.
- Irritable Bowel Syndrome (IBS): Although IBS can cause abdominal cramping and changes in bowel habits, the acute onset and severity of the patient's symptoms make this diagnosis less likely.
- Intestinal Obstruction: The patient's inability to have a normal bowel movement and severe abdominal cramping could suggest an intestinal obstruction. However, the ability to pass gas makes this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Appendicitis: Although the patient's pain is not typically localized to the right lower quadrant, appendicitis can present atypically, especially in older adults. Missing this diagnosis could lead to perforation and severe consequences.
- Mesenteric Ischemia: This condition is a medical emergency that can cause severe abdominal pain, and its diagnosis should be considered, especially in older adults with risk factors such as smoking.
- Ovarian Torsion (less likely in males, but can occur in rare cases): Although extremely rare in males, ovarian torsion can cause severe abdominal pain and should be considered in the differential diagnosis to avoid missing this potentially life-threatening condition.
- Rare diagnoses
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause severe abdominal cramping and changes in bowel habits. However, the acute onset and lack of other symptoms such as weight loss, diarrhea, or blood in the stool make this diagnosis less likely.
- Colonic Volvulus: This condition involves the twisting of a portion of the colon and can cause severe abdominal pain and obstruction. Although rare, it should be considered in the differential diagnosis, especially if the patient's symptoms worsen or do not improve with treatment.