Differential Diagnosis

The patient presents with severe abdominal pain, distention, vomiting, and a history of recent decreased bowel movements. Considering these symptoms, the differential diagnosis can be categorized as follows:

• Single most likely diagnosis
  • A) Adhesions: The patient has a history of appendectomy, which increases the risk of adhesions. Adhesions can cause bowel obstruction, leading to symptoms such as abdominal pain, distention, vomiting, and decreased bowel movements. The high-pitched bowel sounds further support this diagnosis.
• Other Likely diagnoses
  • C) Colorectal tumor: Although less likely in a 27-year-old, a colorectal tumor could cause bowel obstruction, leading to similar symptoms. The patient's frequent eating in restaurants might increase the risk of a diet-related colorectal issue.
  • D) Food poisoning: Given the patient's frequent restaurant meals, food poisoning is a possible cause of his symptoms, although it might not fully explain the abdominal distention and high-pitched bowel sounds.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • B) Alcohol withdrawal: Although the patient has cut back on alcohol, severe alcohol withdrawal can cause abdominal symptoms, among others. It's crucial to consider this diagnosis due to the patient's history of significant alcohol consumption.
  • E) Viral gastroenteritis: While viral gastroenteritis typically presents with diarrhea, it can sometimes cause abdominal pain and vomiting. However, the abdominal distention and high-pitched bowel sounds are less typical for this diagnosis.
• Rare diagnoses
  • Other rare causes of bowel obstruction, such as intussusception or volvulus, could also be considered, although they are less likely given the patient's presentation and history.

It's essential to conduct further evaluation, including imaging studies and laboratory tests, to confirm the diagnosis and guide management.