Differential Diagnosis for 72-year-old Female with Liquid Abdominal Pain and Negative CT Scan Abdomen
Single Most Likely Diagnosis
- Constipation: Given the liquid abdominal pain and pulling sensation, constipation is a common cause of abdominal discomfort in elderly females, especially if there's a change in bowel habits or if the patient is not passing stools regularly. The negative CT scan does not rule out constipation, as it is a clinical diagnosis.
Other Likely Diagnoses
- Gastroenteritis: This could cause liquid abdominal pain and a pulling sensation, especially if the patient has been experiencing diarrhea or vomiting. A negative CT scan does not exclude gastroenteritis, as it is primarily diagnosed based on clinical symptoms.
- Irritable Bowel Syndrome (IBS): IBS can cause chronic abdominal pain and changes in bowel habits, which might fit the description of liquid abdominal pain and a pulling sensation. IBS is a diagnosis of exclusion and could be considered if other causes are ruled out.
- Diverticulitis: Although the CT scan is negative, diverticulitis can sometimes be missed on CT, especially if it's early or mild. Clinical suspicion remains based on symptoms and risk factors.
Do Not Miss Diagnoses
- Ovarian Torsion: Although less common, ovarian torsion can present with severe, sudden-onset abdominal pain and can be a surgical emergency. A negative CT scan does not rule out ovarian torsion, and clinical suspicion should remain high if the pain is severe and acute.
- Mesenteric Ischemia: This is a life-threatening condition that can present with abdominal pain out of proportion to physical examination findings. A high index of suspicion is required, especially in elderly patients with risk factors for vascular disease.
- Ectopic Pregnancy: Although unlikely in a 72-year-old female, it's not impossible, especially with assisted reproductive technologies. However, this would be extremely rare and other symptoms like vaginal bleeding might be present.
Rare Diagnoses
- Intestinal Obstruction: This can cause severe abdominal pain and changes in bowel habits. While a CT scan is sensitive for obstruction, it's not 100% specific, and clinical correlation is necessary.
- Inflammatory Bowel Disease (IBD): Conditions like Crohn's disease or ulcerative colitis can cause chronic abdominal pain and changes in bowel habits. These are less common in new presentations at the age of 72 but should be considered if other diagnoses are excluded.
- Abdominal Migraine: A rare condition that can cause recurrent episodes of severe abdominal pain, often with a pulling sensation, and can be associated with other migraine symptoms.