Differential Diagnosis for Abdominal Wall Stranding with Elevated White Count

Single Most Likely Diagnosis

• Diverticulitis: This condition is a common cause of abdominal wall stranding and elevated white blood cell count, especially if the diverticulitis is complicated by an abscess or perforation. The inflammation and infection associated with diverticulitis can lead to stranding in the abdominal wall and a significant increase in white blood cell count.

Other Likely Diagnoses

• Appendicitis: Similar to diverticulitis, appendicitis can cause abdominal wall stranding due to inflammation and infection spreading to the surrounding tissues. An elevated white blood cell count is a common finding in appendicitis, indicating the body's response to infection.
• Surgical Site Infection: If the patient has a recent history of abdominal surgery, a surgical site infection could be a likely cause of abdominal wall stranding and elevated white blood cell count. Infections at surgical sites can lead to significant inflammation and an elevated white count.
• Intra-abdominal Abscess: An abscess within the abdominal cavity can cause stranding in the abdominal wall, especially if the abscess is located near the abdominal wall or has ruptured, spreading infection to the surrounding tissues. An elevated white blood cell count would be expected in response to the infection.

Do Not Miss Diagnoses

• Necrotizing Fasciitis: Although less common, necrotizing fasciitis is a life-threatening condition that requires immediate attention. It can cause abdominal wall stranding and a significantly elevated white blood cell count due to the severe infection and necrosis of the fascia. Missing this diagnosis could be fatal.
• Perforated Viscus: A perforation of any abdominal organ (e.g., perforated ulcer, perforated intestine) can lead to peritonitis, which may cause abdominal wall stranding and an elevated white blood cell count. This condition is a surgical emergency.

Rare Diagnoses

• Epidural or Subfascial Abscess: These are less common infections that can occur in the epidural space or beneath the fascia. They can cause stranding in the abdominal wall and an elevated white blood cell count but are less likely than other diagnoses listed here.
• Abdominal Wall Cellulitis: While cellulitis itself is not rare, when it involves the abdominal wall and presents with significant stranding and an elevated white count, it might be considered less common compared to other infectious processes listed above.