Differential Diagnosis for 70-year-old Woman with Abdominal Distension and Vomiting
Single Most Likely Diagnosis
- Incercerated Hernia: The presence of a round, tender, non-reducible swelling in the right groin, below and lateral to the pubic tubercle, along with abdominal distension and vomiting, strongly suggests an incarcerated hernia. The symptoms of abdominal distension and vomiting, combined with the X-ray findings of distended small bowel with multiple fluid levels, support this diagnosis as the hernia is likely causing bowel obstruction.
Other Likely Diagnoses
- Bowel Obstruction: The X-ray findings of distended small bowel with multiple fluid levels are indicative of a bowel obstruction. This could be due to various causes, including adhesions, hernias, or tumors, but the presence of a hernia makes an obstructed hernia a more specific concern.
- Adhesional Bowel Obstruction: Given the patient's history of previous surgeries (indicated by "p7+1"), adhesional bowel obstruction is a plausible diagnosis. However, the presence of a palpable hernia shifts the likelihood towards a hernia-related obstruction.
Do Not Miss Diagnoses
- Strangulated Hernia: Although the patient presents with signs suggestive of an incarcerated hernia, the possibility of the hernia being strangulated (where the blood supply to the herniated bowel is compromised) must be considered. Strangulation is a surgical emergency and can lead to bowel necrosis and perforation if not promptly addressed.
- Mesenteric Ischemia: This condition, involving insufficient blood flow to the intestines, can present with abdominal pain, vomiting, and signs of bowel obstruction. It is less likely given the specific findings but is critical to consider due to its high mortality rate if not treated promptly.
Rare Diagnoses
- Internal Hernia: Although less common and not directly suggested by the palpable groin swelling, an internal hernia could cause bowel obstruction. This would be considered if other more likely diagnoses are ruled out.
- Volvolus: A twisting of a portion of the intestine, which can cause obstruction and ischemia. This diagnosis is less likely given the specific presentation but remains a consideration in the differential diagnosis of bowel obstruction.