Differential Diagnosis for Post-Gastrectomy Patient with Elevated WBCs
The patient's presentation of elevated WBCs, normal NGT, 150 ml of drain output, and a soft, lax abdomen 3 days after undergoing gastrectomy with Roux en Y gastrojejunostomy suggests an infectious or inflammatory process. Here's a categorized differential diagnosis:
- Single Most Likely Diagnosis
- B. Jejunal leakage: This is a common complication following Roux-en-Y gastrojejunostomy. The presence of elevated WBCs and drain output, even if not high, could indicate a leak, especially if the fluid is not clearly bilious or if there's a suspicion of infection.
- Other Likely Diagnoses
- D. Oesophagojejunal leak: Although less common than jejunal leakage, an oesophagojejunal leak could present with similar symptoms, including elevated WBCs and signs of infection or sepsis.
- A. Duodenal stump blow out: This is a serious complication but might be less likely given the soft and lax abdomen. However, it cannot be ruled out without further investigation, especially if there's a sudden increase in drain output or signs of peritonitis.
- Do Not Miss Diagnoses
- A. Duodenal stump blow out: Despite being potentially less likely based on the physical exam, a duodenal stump blowout is a life-threatening condition that requires immediate intervention. The presence of any signs of peritonitis, sepsis, or a significant increase in drain output should prompt urgent evaluation.
- D. Oesophagojejunal leak: Similar to a duodenal stump blowout, an oesophagojejunal leak can lead to severe consequences, including sepsis and death, if not promptly diagnosed and treated.
- Rare Diagnoses
- C. Jejunojejunostomy: Issues at the jejunojejunostomy site, such as a leak or obstruction, are less common and might not directly explain the elevated WBCs without other specific symptoms like bowel obstruction signs or a significant change in drain output characteristics.
- Other infectious complications: Such as pneumonia, urinary tract infections, or line infections, which could also cause elevated WBCs but would typically have other accompanying symptoms or signs.