Differential Diagnosis for Mid Right Abdominal Pain
Given the symptoms of mid right abdominal pain on deep palpation, chronic in nature, without bloody diarrhea, and a recent colonoscopy with normal results, the following differential diagnoses can be considered:
- Single most likely diagnosis
- Ileocecal Crohn's Disease: Although the recent colonoscopy was normal, Crohn's disease can be patchy and might not be detected if the affected areas were not visualized or if the disease is primarily in the small intestine. The lack of bloody diarrhea does not rule out Crohn's, as it can present with a variety of symptoms including abdominal pain.
- Other Likely diagnoses
- Appendicitis (Chronic or Recurrent): Chronic appendicitis can cause recurrent or persistent right lower quadrant pain. The fact that the pain is on deep palpation suggests an inflammatory process that could involve the appendix.
- Intestinal Obstruction (Partial or Intermittent): This could cause chronic abdominal pain, especially if the obstruction is partial or intermittent. The location of the pain could suggest involvement of the ileum.
- Mesenteric Lymphadenitis: Inflammation of the lymph nodes in the mesentery can cause abdominal pain, often in the right lower quadrant, and can be chronic.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Ectopic Pregnancy (in Women of Childbearing Age): Although less likely given the chronic nature of the pain, an ectopic pregnancy can present with abdominal pain and must be considered, especially in women of childbearing age.
- Ovarian Torsion (in Women): This is a surgical emergency that can cause severe abdominal pain. Although it might not typically present as chronic pain, intermittent torsion could lead to chronic symptoms.
- Intestinal Ischemia: Reduced blood flow to the intestines can cause chronic pain and is a condition that requires prompt diagnosis and treatment to prevent serious complications.
- Rare diagnoses
- Carcinoid Tumor: These tumors can cause chronic abdominal pain due to the production of serotonin and other substances. They are often found in the small intestine and can be difficult to diagnose.
- Malrotation of the Intestine: Although typically diagnosed in childhood, some cases can go undiagnosed until adulthood and can cause chronic abdominal pain due to intermittent obstruction.
- Intra-abdominal desmoid tumors: These are rare, benign tumors that can cause chronic abdominal pain and are often associated with Gardner syndrome.
Each of these diagnoses should be considered in the context of the patient's full clinical picture, including additional symptoms, medical history, and the results of any diagnostic tests that have been performed.