Differential Diagnosis for a 67-year-old man with bloody diarrhea, abdominal pain, fever, tachycardia, and hypotension
- Single most likely diagnosis
- Toxic Megacolon: This condition is characterized by a very inflated colon, accompanied by abdominal distension, fever, abdominal pain, or other symptoms. The presence of a 10 cm dilation in the transverse colon, along with symptoms like bloody diarrhea, fever, and hypotension, strongly suggests toxic megacolon, particularly in the context of inflammatory bowel disease (IBD) or infectious colitis.
- Other Likely diagnoses
- Infectious Colitis: Conditions such as Clostridioides difficile infection, which can cause severe diarrhea, abdominal pain, and fever, could lead to the observed colon dilation and systemic symptoms.
- Ischemic Colitis: Although less likely given the acute presentation and systemic symptoms, ischemic colitis could potentially cause abdominal pain and bloody diarrhea, especially in the context of hypotension which might impair colonic perfusion.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Perforated Visculitis or Diverticulitis: These conditions could present with similar symptoms and would require immediate surgical intervention. The presence of fever, abdominal pain, and hypotension, along with a significant elevation in white blood cells, necessitates considering these diagnoses to avoid missing a potentially fatal condition.
- Colonic Volvulus: Although the imaging specifically mentions a dilation without clear indication of volvulus, this condition can cause obstruction and ischemia, leading to severe symptoms and requiring urgent intervention.
- Rare diagnoses
- Colonic Pseudo-obstruction (Ogilvie Syndrome): This condition involves a massive dilation of the colon without any mechanical obstruction, often seen in critically ill patients or those with significant comorbidities. While it could explain the dilation, the presence of bloody diarrhea and fever might be less typical for this diagnosis.
- Inflammatory Bowel Disease (IBD) Flare: While IBD (such as ulcerative colitis or Crohn's disease) can lead to toxic megacolon, the question does not provide a history of IBD. However, it remains a consideration, especially if the patient has an undiagnosed condition or if this represents the initial presentation of IBD.