Differential Diagnosis for Abdominal Pain and Contrast in Ascending Colon

• Single most likely diagnosis:
  • Diverticulitis or colitis with contrast extravasation: The presence of contrast in the ascending colon without a history of recent oral contrast could be due to extravasation of contrast from a perforated viscus, such as in the case of diverticulitis or colitis. The thickening of the right colon supports this diagnosis.
• Other Likely diagnoses:
  • Cannabis hyperemesis syndrome with secondary condition: The patient's initial presentation with intractable nausea and vomiting and generalized abdominal pain is consistent with cannabis hyperemesis syndrome. However, the presence of contrast in the ascending colon and thickening of the right colon may indicate a secondary condition such as colitis or diverticulitis.
  • Inflammatory bowel disease (IBD): The thickening of the right colon and presence of contrast could be indicative of IBD, such as Crohn's disease or ulcerative colitis.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Perforated viscus: A perforated viscus, such as a perforated appendix or perforated diverticulum, could lead to contrast extravasation and would require immediate surgical intervention.
  • Ischemic bowel: Ischemic bowel disease could present with abdominal pain and thickening of the bowel wall, and would require prompt diagnosis and treatment to prevent bowel infarction.
• Rare diagnoses:
  • Intussusception: Intussusception is a rare condition in adults, but could present with abdominal pain and thickening of the bowel wall. The presence of contrast in the ascending colon could be indicative of intussusception.
  • Gastrointestinal lymphoma: Gastrointestinal lymphoma is a rare condition that could present with abdominal pain, thickening of the bowel wall, and contrast extravasation.