Differential Diagnosis for the Male Patient with Swelling in Front of the Ear

• Single most likely diagnosis:
  • Infected sebaceous cyst: This is the most likely diagnosis given the description of a long-lasting swelling that is adherent to the skin, painful, and associated with redness. Sebaceous cysts can become infected, leading to such symptoms.
• Other Likely diagnoses:
  • Parotid abscess: Although less common, a parotid abscess could present with swelling, pain, and redness in front of the ear, especially if the infection involves the parotid gland.
  • Pleomorphic adenoma: This is a common benign tumor of the salivary glands, which could cause a long-standing swelling. However, it is typically not painful or associated with redness unless it becomes infected.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Malignant tumor: Although rare, a malignant tumor in the parotid gland or surrounding tissues could present with similar symptoms, especially if there's significant pain, rapid growth, or associated neurological deficits.
• Rare diagnoses:
  • Face lipoma: Lipomas are benign tumors of fat tissue and are less likely to cause painful, red, and long-standing swellings in front of the ear.
  • Other rare infections or conditions: Such as actinomycosis, which is a rare bacterial infection that can cause chronic, painful swellings.

Differential Diagnosis for the Post-Gastrectomy Patient

• Single most likely diagnosis:
  • Jejunal leakage: Given the elevated WBCs and the presence of a drain with 150 ml of output 3 days post-gastrectomy with Roux-en-Y gastrojejunostomy, a leakage from the jejunojejunostomy site is a plausible cause. The soft and lax abdomen might suggest that the leakage is contained, but the elevated WBCs indicate an infectious or inflammatory process.
• Other Likely diagnoses:
  • Duodenal stump blow out: This is a serious complication that can occur after gastrectomy, where the duodenal stump leaks. It's less likely given the absence of specific symptoms like severe abdominal pain or significant peritoneal signs, but it cannot be ruled out without further investigation.
  • Oesophagojejunal leak: A leak from the oesophagojejunal anastomosis could also lead to elevated WBCs and signs of infection. However, the clinical presentation might differ, with possible signs of mediastinitis or more severe sepsis.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Duodenal stump blow out: Although mentioned as an other likely diagnosis, it's crucial to emphasize that missing this diagnosis could be catastrophic. It requires prompt surgical intervention.
  • Major vascular complication: Although not directly suggested by the information provided, any post-surgical patient with signs of infection or sepsis should be evaluated for potential vascular complications, such as bleeding or thrombosis, which could be life-threatening.
• Rare diagnoses:
  • Jejunojejunostomy issues other than leakage: While the jejunojejunostomy site is a common area for complications, issues other than leakage (like stenosis or internal hernia) might present differently and are less likely to cause elevated WBCs in the early post-operative period.