Differential Diagnosis for Abdominal Pain
The patient's presentation of constant abdominal pain, lack of appetite, and tenderness in the left lower abdominal quadrant, along with the laboratory and imaging findings, guides the differential diagnosis.
Single Most Likely Diagnosis
- Diverticulitis: The CT scan findings of bowel wall thickening and fat stranding, combined with the patient's symptoms of constant abdominal pain, tenderness in the left lower quadrant, and fever, are highly suggestive of diverticulitis. The patient's age and the absence of nausea or vomiting also support this diagnosis.
Other Likely Diagnoses
- Bowel Obstruction: Although the patient can tolerate solids and liquids, the diminished bowel sounds and the history of diarrhea followed by cessation of bowel movements could suggest a partial bowel obstruction. However, the absence of significant nausea or vomiting and the specific CT findings make this less likely than diverticulitis.
- Appendicitis: Typically presents with pain that migrates to the right lower quadrant, which is not the case here. The left lower quadrant tenderness and the CT findings do not strongly support appendicitis, but it cannot be entirely ruled out without further evaluation.
- Pancreatitis: The patient's use of naproxen could be a risk factor for pancreatitis, but the lack of upper abdominal pain radiating to the back and the specific CT findings make this diagnosis less likely.
Do Not Miss Diagnoses
- Perforated Visculitis or Ischemic Bowel Disease: Given the patient's age, hypertension, and the presence of warm, boggy tissue texture on examination, it's crucial to consider vascular causes of abdominal pain, such as a perforated viscus or ischemic bowel disease, which could have a high mortality if missed.
- Inflammatory or Infectious Processes: Conditions like an intra-abdominal abscess, pyelonephritis, or even a spinal infection (given the description of warm, boggy tissue at T10-L2) could present with similar symptoms and would require prompt diagnosis and treatment.
Rare Diagnoses
- Neurogenic Causes: Although less likely, conditions affecting the nerves that innervate the abdominal region, such as herpes zoster or nerve root compression, could cause abdominal pain and should be considered if other diagnoses are ruled out.
- Intra-abdominal Malignancy: While rare, certain malignancies could present with abdominal pain and should be considered, especially in the context of significant weight loss or other systemic symptoms, which are not prominently featured in this case.