Differential Diagnosis for Abdominal Pain with High Hgb Hct and WBC, Fecal Material on XRay, and Hypokalemia

• Single Most Likely Diagnosis
  • Intestinal Obstruction: The presence of fecal material on the X-ray, abdominal pain, and high white blood cell count (WBC) suggests a possible intestinal obstruction. The high hemoglobin (Hgb) and hematocrit (Hct) could be due to dehydration, which is common in obstruction due to vomiting and decreased oral intake. Hypokalemia can occur due to loss of potassium through vomiting.
• Other Likely Diagnoses
  • Bowel Ischemia: This condition can present with abdominal pain, elevated WBC, and could potentially show fecal material on an X-ray if there's associated obstruction or ileus. Hypokalemia might be seen due to various factors including reperfusion injury.
  • Inflammatory Bowel Disease (IBD) Flare: While less likely to show fecal material on an X-ray, a severe flare of IBD (like Crohn's disease or ulcerative colitis) can cause abdominal pain, high WBC, and potentially lead to hypokalemia through diarrhea.
• Do Not Miss Diagnoses
  • Perforated Viscus: Although the X-ray description does not specifically mention free air, any condition leading to perforation (e.g., appendicitis, diverticulitis) can present with abdominal pain, elevated WBC, and potentially altered bowel habits. The presence of fecal material could be indicative of a perforation with leakage into the peritoneal cavity. This is a surgical emergency.
  • Mesenteric Thrombosis: This condition can cause bowel ischemia and presents with severe abdominal pain out of proportion to physical examination findings, elevated WBC, and potentially signs of obstruction. It's crucial to consider this diagnosis due to its high mortality rate if not promptly treated.
• Rare Diagnoses
  • Pseudomembranous Colitis: Caused by Clostridioides difficile infection, it can lead to abdominal pain, elevated WBC, and diarrhea, potentially resulting in hypokalemia. While less likely to show fecal material on an X-ray in a manner suggestive of obstruction, it's a consideration in patients with recent antibiotic use.
  • Ovarian Torsion: Although more commonly presenting with acute, severe pain and potentially a mass on imaging, ovarian torsion can occasionally cause nonspecific abdominal pain and elevated WBC. It's less likely to cause the specific combination of findings mentioned but is a rare condition that could potentially lead to severe consequences if missed.