Differential Diagnosis for 77 yo woman undergoing TURP
- Single most likely diagnosis
- Perforation of the bladder with extravesical fat exposure: This is the most likely diagnosis given the presence of fat near the trigone and left ureter orifice in the area of deep resection during TURP, combined with abdominal distension. The procedure itself can lead to perforation, especially with deep resections, and the symptoms described are consistent with this complication.
- Other Likely diagnoses
- Abscess formation: Although less directly related to the immediate findings of fat near the trigone, an abscess could form as a complication of the procedure, especially if there was a perforation. Abdominal distension could be a symptom of an abscess.
- Hemorrhage or hematoma: Bleeding is a common complication of TURP, and a significant hemorrhage or hematoma could cause abdominal distension and potentially displace or compress structures, leading to the observed fat near the ureter orifice.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Sepsis: Although not directly implied by the findings, any perforation or significant bleeding could lead to infection, and in an elderly patient, sepsis is a potentially deadly complication that must be considered and promptly treated.
- Ureteral injury: The proximity of the fat to the left ureter orifice raises the possibility of ureteral injury during the procedure. This is a serious complication that could lead to significant morbidity if not recognized and addressed.
- Rare diagnoses
- Malignant tumor invasion: While the patient is undergoing TURP for papillary tumors, the presence of fat near the trigone could, in rare cases, suggest invasive tumor growth, although this would be less likely given the context of the procedure and the description provided.
- Congenital or acquired diverticulum of the bladder: A pre-existing diverticulum could potentially be involved in the area of resection, leading to the observed findings, though this would be less directly related to the immediate complications of TURP.