Differential Diagnosis for Abdominal Pain in a 55-year-old Female Smoker
- Single most likely diagnosis:
- Diverticulitis: This is the most likely diagnosis given the patient's presentation of left lower quadrant abdominal pain, distal sigmoid edema, and narrowing seen during colonoscopy. The patient's age and smoking history also increase the risk for diverticulitis.
- Other Likely diagnoses:
- Colorectal cancer: The presence of distal sigmoid edema and narrowing could also be indicative of a colorectal cancer, especially in a smoker. The difficulty in traversing the sigmoid colon during colonoscopy raises suspicion for a possible obstructing lesion.
- Inflammatory bowel disease (IBD): Although less likely, IBD such as Crohn's disease or ulcerative colitis could present with similar symptoms and findings, including narrowing and edema of the sigmoid colon.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Perforation: Given the worsening abdominal pain after the colonoscopy, perforation of the sigmoid colon is a critical diagnosis that must not be missed. This could be related to the diverticulitis or the procedure itself.
- Ischemic colitis: This condition, although less common, can present with abdominal pain and changes in the colon similar to those described. It is crucial due to its potential for severe outcomes if not promptly addressed.
- Rare diagnoses:
- Lymphoma or other rare malignancies: These could cause narrowing and edema of the sigmoid colon but are less common than diverticulitis or colorectal cancer.
- Eosinophilic colitis: A rare condition that could present with similar symptoms, though it would be an unusual diagnosis in this context.