Differential Diagnosis

The patient's presentation of weakness, diarrhea, jaundice, and glossitis three years after radical cystectomy and ileal conduit, with a history of Crohn's disease, suggests a complex interplay of potential complications and conditions. Here's a categorized differential diagnosis:

• Single Most Likely Diagnosis
  • Malabsorption due to short bowel syndrome: This is a likely diagnosis given the patient's history of Crohn's disease and the surgical removal of a portion of the intestine (ileal conduit creation). The symptoms of diarrhea, weakness, and jaundice can be attributed to the malabsorption of essential nutrients and bile salts.
• Other Likely Diagnoses
  • Vitamin B12 deficiency: This is a common complication in patients with a history of ileal resection, as the ileum is the primary site of vitamin B12 absorption. The symptoms of weakness, diarrhea, and glossitis are consistent with a vitamin B12 deficiency.
  • Chronic kidney disease: The patient's elevated serum creatinine level suggests impaired renal function, which could be a consequence of the radical cystectomy, underlying Crohn's disease, or other factors.
  • Anemia of chronic disease: The patient's low hemoglobin level, in the context of chronic Crohn's disease and potential renal impairment, suggests anemia of chronic disease.
• Do Not Miss Diagnoses
  • Intestinal obstruction or stricture: Although less likely, given the patient's symptoms, an intestinal obstruction or stricture could lead to severe complications, including bowel ischemia and perforation, if not promptly addressed.
  • Septicemia or abscess: Patients with Crohn's disease and a history of surgery are at increased risk of developing infections, which can be life-threatening if not recognized and treated promptly.
  • Adenocarcinoma of the small intestine: Although rare, the patient's history of Crohn's disease increases the risk of developing small intestine adenocarcinoma, which can present with nonspecific symptoms like diarrhea and weight loss.
• Rare Diagnoses
  • Zinc deficiency: This can occur in patients with short bowel syndrome or Crohn's disease, leading to symptoms like diarrhea, weakness, and skin lesions.
  • Copper deficiency: Similar to zinc deficiency, copper deficiency can occur in patients with malabsorption and lead to hematological and neurological symptoms.
  • Intestinal lymphoma: Patients with long-standing Crohn's disease are at increased risk of developing intestinal lymphoma, which can present with nonspecific symptoms like diarrhea, weight loss, and abdominal pain.