Differential Diagnosis

The provided report outlines various findings, including fecal loading throughout the colon, a mobile cecum, and fluid-filled small bowel loops, among others. Based on these findings, the differential diagnosis can be categorized as follows:

• Single Most Likely Diagnosis
  • Constipation: Given the fecal loading throughout the colon, particularly in the cecum, and the presence of a mobile cecum, constipation is a plausible explanation. The absence of pericecal inflammation and no obvious inflamed or distended large or small bowel loop supports this diagnosis.
• Other Likely Diagnoses
  • Intestinal obstruction: Although there's no obvious distended bowel loop, the presence of multiple fluid-filled small bowel loops abutting the cecal pole could suggest a partial obstruction.
  • Gastroenteritis: The fluid-filled small bowel loops and mild to moderate free fluid in the cul-de-sac could be indicative of an infectious or inflammatory process affecting the gastrointestinal tract.
  • Ovarian cysts or uterine fibroids causing pelvic discomfort: The bulky uterus with questionable fibroids and bilateral ovarian cysts could be contributing to the patient's symptoms, especially if there's associated pelvic pain or pressure.
• Do Not Miss Diagnoses
  • Appendicitis: Although the appendix is not confidently identified and there's no pericecal inflammation, appendicitis is a critical diagnosis that must be considered, especially with the clinical presentation and the proximity of fluid-filled small bowel loops to the cecal pole.
  • Intussusception: Given the presence of fluid-filled small bowel loops and the mobile cecum, intussusception, although less common in adults, should be considered as it can lead to bowel obstruction and ischemia.
  • Diverticulitis: The presence of fecal loading and the potential for inflammation, even though not clearly identified, makes diverticulitis a diagnosis that should not be missed, especially if the patient has risk factors or symptoms suggestive of this condition.
• Rare Diagnoses
  • Cecal volvulus: The mobile cecum located in the lower central pelvis could potentially suggest a cecal volvulus, although this is less common and typically presents with more pronounced symptoms of obstruction.
  • Internal hernia: The presence of fluid-filled small bowel loops and the mobile cecum might rarely suggest an internal hernia, which could lead to bowel obstruction and ischemia if not addressed promptly.

Each of these diagnoses is considered based on the provided imaging findings, and clinical correlation with the patient's symptoms and medical history is essential for making an accurate diagnosis.