Differential Diagnosis for 75-year-old Patient
Single Most Likely Diagnosis
- Small Bowel Obstruction: The presence of edematous jejunal bowel loops and increasing counts despite antibiotics suggests a mechanical obstruction. The new onset fever and thrombocytosis could be indicative of an underlying infection or inflammation secondary to the obstruction.
Other Likely Diagnoses
- Infectious Enteritis: The combination of fever, anemia, and edematous bowel loops could suggest an infectious process, particularly if the patient has been exposed to pathogens or has a history of recent travel.
- Inflammatory Bowel Disease (IBD): Although less common in the elderly, IBD (e.g., Crohn's disease, ulcerative colitis) could present with similar symptoms, including anemia, fever, and bowel edema.
- Ischemic Bowel Disease: Given the patient's age, ischemic bowel disease is a possibility, especially if there are underlying vascular risk factors not mentioned. The edematous bowel loops and anemia could be consistent with this diagnosis.
Do Not Miss Diagnoses
- Mesenteric Ischemia: This is a medical emergency that requires prompt diagnosis and treatment. The symptoms of abdominal pain, fever, and bowel edema could be indicative of mesenteric ischemia, which would be catastrophic if missed.
- Bowel Infarction: Similar to mesenteric ischemia, bowel infarction is a life-threatening condition that could present with the described symptoms and would require immediate surgical intervention.
- Neutropenic Enterocolitis (Typhlitis): Although the patient has thrombocytosis, the presence of fever, anemia, and bowel edema could suggest neutropenic enterocolitis, particularly if the patient has an underlying hematologic malignancy or is on immunosuppressive therapy.
Rare Diagnoses
- Ehlers-Danlos Syndrome with Bowel Involvement: A rare genetic disorder that could lead to bowel perforation or obstruction, presenting with similar symptoms.
- Amyloidosis with Gastrointestinal Involvement: A condition where amyloid deposits in the bowel could lead to obstruction, ischemia, or other gastrointestinal symptoms.
- Scleroderma with Bowel Involvement: A rare autoimmune disorder that could affect the bowel, leading to symptoms such as obstruction, ischemia, or chronic inflammation.