Differential Diagnosis for Chronic Soreness of Abdominal Pain on Deep Palpation

Single Most Likely Diagnosis

• Irritable Bowel Syndrome (IBS): This condition is characterized by chronic abdominal pain, bloating, and changes in bowel movements. The pain associated with IBS can be exacerbated by deep palpation, making it a plausible cause for chronic soreness on deep palpation.

Other Likely Diagnoses

• Chronic Constipation: Prolonged constipation can lead to abdominal pain and discomfort, which may worsen with deep palpation due to the increased pressure on the abdominal contents.
• Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease and ulcerative colitis can cause chronic abdominal pain, which may be more pronounced on deep palpation due to the inflammation and potential scarring of the intestinal tissues.
• Gastroesophageal Reflux Disease (GERD): Although primarily associated with heartburn, GERD can also cause abdominal pain and discomfort, especially if the stomach acid flows up into the abdomen, potentially causing pain on deep palpation.

Do Not Miss Diagnoses

• Appendicitis: Although appendicitis typically presents with acute pain, chronic or recurrent appendicitis can cause chronic abdominal pain that worsens with deep palpation. Missing this diagnosis could lead to severe complications, including perforation.
• Ovarian Cysts or Torsion: In females, ovarian cysts or torsion can cause chronic abdominal pain, especially if the cysts are large or if torsion occurs intermittently. These conditions require prompt medical attention to prevent complications like cyst rupture or ovarian necrosis.
• Abdominal Aortic Aneurysm: A slowly expanding abdominal aortic aneurysm can cause chronic abdominal pain, which may be more noticeable on deep palpation. This condition is life-threatening if the aneurysm ruptures, making it crucial not to miss.

Rare Diagnoses

• Abdominal Wall Pain: Also known as abdominal cutaneous nerve entrapment syndrome, this condition involves the entrapment of nerves in the abdominal wall, leading to chronic pain that can be exacerbated by deep palpation.
• Sickle Cell Disease: Individuals with sickle cell disease can experience chronic abdominal pain due to sickling crises, which may worsen with deep palpation.
• Chronic Intestinal Pseudo-Obstruction: This rare condition involves the weakening of the intestinal muscles, leading to severe abdominal pain, bloating, and changes in bowel habits, which could potentially worsen with deep palpation.