Differential Diagnosis for 70-year-old Male with Abdominal Pain and Bowel Obstruction Symptoms

The patient's presentation suggests a bowel obstruction, which can be caused by various factors. The differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis

  • Mechanical Bowel Obstruction: Given the patient's symptoms of abdominal pain, incomplete bowel movements, and abdominal distension, a mechanical bowel obstruction is the most likely diagnosis. This condition occurs when the normal flow of intestinal contents is blocked, which can be due to various causes such as adhesions from previous surgeries, hernias, or tumors.

• Other Likely Diagnoses

  • Constipation: Although less likely given the acute presentation, constipation could cause similar symptoms, especially in elderly patients who may have decreased mobility or are on medications that can cause constipation.
  • Diverticulitis: Inflammation of a diverticulum in the wall of the colon could cause abdominal pain and changes in bowel habits, although it typically presents with more localized pain and possibly fever.
  • Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis could cause chronic symptoms but might also present acutely, especially if there's a complication like a stricture.

• Do Not Miss Diagnoses

  • Volvulus: A condition where a loop of intestine twists around itself and the tissue that holds it in place, cutting off blood flow. It's a surgical emergency and can present with severe abdominal pain and obstruction symptoms.
  • Intussusception: A condition where a part of the intestine slides into an adjacent part, potentially cutting off blood supply. It's more common in children but can occur in adults, often due to a lead point like a tumor.
  • Ischemic Bowel: Reduced blood flow to the intestines can cause severe abdominal pain, and if not promptly treated, can lead to necrosis of the bowel tissue.
  • Perforated Viscus: A hole in the wall of the stomach or intestine can lead to peritonitis, an infection of the abdominal cavity, which is a life-threatening condition.

• Rare Diagnoses

  • Internal Hernia: A rare condition where there is protrusion of an organ or tissue through a defect within the peritoneal cavity, which can cause bowel obstruction.
  • Gallstone Ileus: A rare complication of gallstones where a stone enters the bowel through a fistula and causes a mechanical obstruction, typically in the small intestine.
  • Carcinoid Tumor: A rare type of tumor that can cause bowel obstruction, either by direct invasion or through desmoplastic reaction causing fibrosis and narrowing of the intestinal lumen.

Orders

Given the clinical presentation, the following orders should be considered:

• Imaging: A CT scan of the abdomen with contrast to evaluate for bowel obstruction, its cause, and potential complications.
• Laboratory Tests: Complete blood count (CBC), basic metabolic panel (BMP), and lactate level to assess for signs of infection, dehydration, or ischemia.
• Nasogastric Tube: To decompress the stomach and prevent vomiting.
• Fluid Resuscitation: To correct dehydration and maintain fluid balance.
• Surgical Consultation: Given the high likelihood of a mechanical bowel obstruction or other surgical conditions, early involvement of a surgical team is crucial.