Differential Diagnosis for Small Bowel Obstruction in an Elderly Female
Single Most Likely Diagnosis
- Obturator hernia: This is a common cause of small bowel obstruction in elderly females without a history of previous surgery or external hernia. Obturator hernias are more common in women due to the wider pelvis, which can lead to a larger obturator canal. The hernia can cause bowel obstruction without being palpable, making it a challenging diagnosis.
Other Likely Diagnoses
- Volvulus: This is a possible cause of small bowel obstruction, especially in the elderly. Volvulus occurs when a portion of the intestine twists around its mesentery, cutting off blood flow. It is more common in older adults and can be caused by conditions such as intestinal malrotation or adhesions.
- Gallstone ileus: This condition occurs when a gallstone enters the intestine through a fistula between the gallbladder and the intestine, causing a mechanical obstruction. It is more common in elderly women and can be a cause of small bowel obstruction without a history of previous surgery.
- Small bowel neoplasm: Although less common, small bowel neoplasms can cause obstruction, especially in the elderly. These tumors can grow slowly over time, eventually causing a blockage in the intestine.
Do Not Miss Diagnoses
- Abdominal abscess: While not a direct cause of mechanical small bowel obstruction, an abdominal abscess can lead to a localized ileus or obstruction due to inflammation and adhesions. Missing this diagnosis could lead to severe consequences, including sepsis and death.
- Intussusception: Although rare in adults, intussusception can occur and cause small bowel obstruction. It is a condition where a part of the intestine telescopes into another part, leading to obstruction and potentially ischemia.
Rare Diagnoses
- Internal hernias (other than obturator hernia): Internal hernias through defects in the intestinal mesentery or other areas can cause small bowel obstruction but are less common.
- Adhesions from previous intra-abdominal processes: Even without a history of surgery, adhesions from previous infections, inflammations, or other intra-abdominal processes can cause small bowel obstruction, though this would be less likely in the absence of any known previous abdominal issues.